APPLICATION FORM FOR DERBY SHAKESPEARE THEATRE COMPANY

I wish to apply for membership of the DSTC

NAME

ADDRESS

TELEPHONE
Home Work

DATE OF BIRTH (if 18 or under)

I AM INTERESTED IN BEING INVOLVED IN
(Please delete those activities you are NOT interested in)

IF YOU ARE KNOWN TO ANY EXISTING MEMBERS, THEN PLEASE GIVE THEIR NAMES

IF YOU ALREADY HAVE SOME THEATRICAL EXPERIENCE PLEASE GIVE BRIEF DETAILS

SIGNATURE

DATE

I ENCLOSE A CHEQUE FOR £ (payable to Derby Shakespeare Theatre Company)

NOTE: Full membership £20.00 per annum
Associate membership (18 or under) £8.00 per annum

PLEASE SEND YOUR COMPLETED FORM AND CHEQUE TO: