Membership Form

Forname:

Surname:

Address:

Town:

Post Code:

Are you happy for us to contact you by email?

(We will not pass your details onto anyone else)

Full Season Membership @ £30 for all shows:

Concessions* @ £20 for all shows:

Total to pay:   £

* Passport to Leisure / Full-time students / Receiving State Pension

I am / We are 16 years of age or over

Signature(s):.............................................................

Date:....................................

Please print this page and send it with your payment to:

Membership Secretary, Halifax Film Society, 13 Grandsmere Place, Halifax HX3 0DP

Cheques should be made payable to “Halifax Film Society”

www.halifaxfilm.org.uk

Telephone:

Email: