PLEASE COMPLETE IN BLOCK LETTERS

Mr/Mrs/Miss/Ms..... .......... (Initials) .............................................. (Surname)
(Delete as appropriate)

Address........................................................................................... ....

......................................... ....................... ... Postcode....... ......................

Tel.No........................ .......... ...(Home)....................................... . (Business)

Signature..................................... .................... .Date...............................

Second Name................................................................ ..Mr/Mrs/Miss/Ms
Goint Membership only)

Signature.................................................. ...

Single 'Gold' (1 Member) £19 Joint 'Gold' (2 Members) £31

Single 'Silver' (lMember) £6.50 Joint 'Silver' (2 Members) £10.50

(Membership runs for 12 months from joining date)

Please find enclosed cash/cheque value £ ......... made payable to Peterborough City Council or Charge my Credit/Charge Card (please tick appropriate card):

Mastercard 0 Visa 0 Maestro 0 Delta 0

Card Number

Expiry Date_ / _ Issue No _ / _ (Maestro only)

Cardholder's Signature..............................................................................

Address (if different to above) .....................................................................

........................................................................................................

Please return completed form to the Box Office either by hand or post to:KTC Membership, Key Theatre, Embankment Road, Peterborough, PEl lEF

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For Office Use Only

Date Banked..........................

Processed by.... . .. . .. . .. . .. .. .. . . . . .. .. . ..

Audit Number.......................

Oub Application 006/Prom.KTC