IVER HEATH

DRAMA CLUB
2009/2010 Membership Form

NAME _______________________________________________________________
Date of Birth DD / MM / YYYY Age _________
Telephone ____________ _____________________________
Address ____________________________________________________
____________________________________________________
Postcode ____________ ____________
Email ______________________ @ _________________________________________

Membership Full Adult Full Junior (U18) Associate

Please note, parents/carers of all junior members must register as Associate members. Please see the Constitution for definitions.

Medical

I.C.E Name/Relationship
In Case of Emergency
Telephone
Second Contact Name/Relationship
If neccessary
Telephone

By signing and completing this form I agree that the information given is correct. I also agree to abide by,
uphold and honour the Constitution and the Code of Conduct for this club. I will pay all membership fees and
actively take part to the best of my ability.
NAME
Signed
Date
If under 18 years, this section is to NAME
be completed by the Associate Signed
member. Date

In accordance with the Data Protection Act; this information will be retained by the club and WILL NOT be passed on to third parties. Never ever, we
promise. We will only use your email address to send to send you our monthly newsletter and vital updates - not spam. If you have any questions contact our
BOX OFFICE on 01753 652 616 or you can find the club on Twitter, Facebook and Youtube.
Registered Office; Sandra Corcoran, 19 Heathway, Iver Heath, Buckinghamshire