Thornbury Picture House - 2011/12 Membership Form

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Please help us by joining early by post.

I/We wish to join TPH film club for the 2011/2012 season
Note: All members must be over the age of 16.

I/We enclose £.........................................
(Cheques payable to Thornbury Picture House)

Please write clearly in Capital Letters.

From (Mr, Mrs, Ms,Miss)

NAME 1------------------------------------------------------------

NAME 2 ------------------------------------------------------------

ADDRESS------------------------------------------------------

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POSTCODE-----------------------------------------------

Telephone--------------------------------------------------

Mobile-------------------------------------------------------------

email 1 --------------------------------------------------------------

email 2 --------------------------------------------------------------

Signed---------------------------------Date--------------------

DPA Statement. Any contact information provided will be used only in connection with Thornbury Picture House and for no other purposes.

Membership fees for 2011/12 season

£30.00 for 1 person £60.00 for 2 people

Please send the completed form with your cheque to:
TPH Membership Secretary
Hollybush Cottage, Clay Lane, Thornbury,
South Glos, BS35 3UA. Tel 01454 412272
email films@thornburypicturehouse.org

Please help us by joining early by post.

I wish to join TPH film club for the 2011/2012 season
Note: All members must be over the age of 16.

I enclose £..30.......................................
(Cheques payable to Thornbury Picture House)