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 Application Form

Please PRINT OFF this page, complete and return with your remittance to the address at the bottom of the page
Mr, Mrs, Miss, Ms (delete as appropriate)
Forenames: Surname:
Address:
 
 
Postcode:
Telephone: E-Mail:

I ENCLOSE a cheque for £10.00 for my Annual Membership (plus hopefully a donation) made payable to The Kenton Theatre.

ENCLOSED AMOUNT:  £..........................
Signed: Dated:

 Please tick box if you are interested in being an Active Friend 

GIFT AID TAX RELIEF

I wish to support the Kenton Theatre, a registered charity, through Gift Aid and declare that my subscription be treated as a Gift Aid donation until I notify otherwise.

I Pay basic rate Tax (please tick) Signed:                Dated:

Please send this form with your payment to
The Kenton Friends Membership Secretary
Miss Sandra Moon
Old Timbers, Friday Street, Henley on Thames, RG9 1AN

 Registered Charity No 253021