Membership form

Membership Form 2022-2023
Type of membership *

Junior Member (under 18) Adult Member (18 and over)
Name of Member *

First Name Last Name
Name of Parent / Carer (Junior Members Only)

First Name Last Name
Postal Address
Preferred Telephone Number *
Alternative Telephone Number (optional)
Email address [this should be the email address of the parent/carer for junior members] [email will be the standard means of communication with the membership] *

Confirmation Email Confirm email
Date of Birth (Junior members only)

Day Month Year
I agree that any picture, image, video or DVD in which I or any of those named above may feature may be published on a web site, or such other place as may be determined appropriate, for the purposes of record, promotion or fund-raising, at the sole discretion of the Executive Committee.

I consent to the details as given above being held on a database and being used by the Society in accordance with the provisions of the Data Protection Act 2018. I will advise the Society promptly of any changes to these details.

I acknowledge safe receipt of the note for parents and carers [junior members only] and consent to my child taking part in the Society’s production(s).
Please confirm your agreement *

I agree to the above.
Date

Day Month Year
Should be Empty:

Membership Form 2022-2023