Patrons 6pp A5 l.let NEW LAYOUT:Layout 1 24/04/2015 16:43 Page 1
As a registered independent charity (No 511567) Birmingham Hippodrome relies on income from ticket and ancillary sales and the generous support of donors like you. Please fill in the whole form using a ball point pen and send it to:
Instruction to your Bank or Building Society to pay by Direct Debit
Birmingham Hippodrome Patrons Birmingham Hippodrome Hurst Street Birmingham B5 4TB
ORIGINATOR’S IDENTIFICATION NUMBER:
|
|
BANK/BUILDING SOCIETY ACCOUNT NUMBER:
|
|
|
|
|
|
|
|
|
|
|
|
|
Instruction to your Bank or Building Society Please pay Birmingham Hippodrome Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct debit Guarantee. I understand that this Instruction may remain with Birmingham Hippodrome and, if so, details will be passed electronically to my Bank/Building Society.
BRANCH SORT CODE:
|
|
|
Name and full postal address of your Bank or Building Society TO: THE MANAGER BANK/BUILDING SOCIETY:
PLAY
Patrons
YOUR PART
Become a Patron to receive fantastic benefits and exclusive access to the theatre you love.
REFERENCE (to be completed by Birmingham Hippodrome):
|
|
“I thought it was brilliant. Just brilliant. I’ve waited 9 years to be able to take my autistic daughter to the theatre and for her to enjoy it” AUDIENCE MEMBER, RELAXED PERFORMANCE
8 | 3 | 0 | 9 | 0 | 8
NAME(S) OF ACCOUNT HOLDER(S):
|
Your support really does make a difference:
“It’s clear that Dance Quest was a stonking success. I’m absolutely over the moon about that.Well done” JEREMY NEWTON, CHIEF EXECUTIVE, THE PRINCE’S FOUNDATION FOR CHILDREN & THE ARTS
ADDRESS:
SIGNATURE(S):
POSTCODE:
DATE:
(To be completed by Birmingham Hippodrome)
BOOKING REF:
EXPIRY DATE:
PROCESSED BY:
DATE PROCESSED:
Please read this guarantee information before signing. A copy of this will be sent to you for your records.
The Direct Debit Guarantee • This guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own Bank or Building Society. • If the amounts to be paid or the payment dates change, Birmingham Hippodrome Theatre will notify you ten working days in advance of your account being debited or as otherwise agreed. • If an error is made by Birmingham Hippodrome Theatre or your Bank or Building Society, you are guaranteed a full and immediate refund from your branch of the amount paid. • You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please also send a copy of your letter to us.
“I enjoy being part of the Hippodrome Family. Being involved in the Relaxed Performance and watching the faces of the audience was magical, the special care shown by everyone at the Hippodrome is a joy” CURRENT PATRON
Details about Birmingham Hippodrome, its charitable activities and its trustees can be found online at birminghamhippodrome.com Birmingham Hippodrome Development Trust is a registered charity (No 511567) All details correct at the time of going to print
From as little as £25 a month, your contribution will directly fund the delivery of our creative and education programmes via
Patrons 6pp A5 l.let NEW LAYOUT:Layout 1 24/04/2015 16:43 Page 4
BECOME A PATRON PLEASE COMPLETE THIS FORM AND RETURN IT TO THE ADDRESS OVERLEAF FROM
£3MO0N0 TH
Hippodrome Circle Patrons £3,000 OR MORE ANNUALLY
A
Or 10 instalments of a minimum of £300
Headline Act Patrons
FROM
£M14ON0TH
£1,400 - £2,999 ANNUALLY
A
Or 10 instalments of a minimum of £140
Our highest level supporters receive all of the Supporting Cast benefits (below) plus: • Ticket credit of £200 a year • • Unlimited use of our Qdos Lounge on show nights for up to 4 people • • Two complimentary uses of a private hospitality suite during an evening performance • • Exclusive invitations from our Chief Executive and Trustees • • A private backstage tour on joining • • The opportunity to Name a Seat in our auditorium on joining •
Headline Act Patrons receive all of the Supporting Cast benefits (below) plus: • Ticket credit of £175 a year • • Unlimited use of our Qdos Lounge on show nights for up to 4 people • • Two complimentary uses of a private hospitality suite during an evening performance • • Invitations to Gala Dinners and Guest Evenings •
YOUR DETAILS TITLE:
FORENAME/INITIALS:
SURNAME:
ADDRESS:
POSTCODE:
TELEPHONE (DAY/EVE):
EMAIL:
MEMBERSHIP DETAILS
Leading Role Patrons
FROM
£7O0 NTH
£700 - £1,399 ANNUALLY
AM
Or 10 instalments of a minimum of £70
I wish to join Birmingham Hippodrome’s Patrons Scheme at the following level: (PLEASE TICK PREFERRED LEVEL) Leading Role Patrons receive all of the Supporting Cast benefits (below) plus: • Ticket credit of £90 a year • • Use of Qdos Lounge on show nights up to 4 times a year for up to 4 people • • Invitations to Gala Dinners and Guest Evenings •
Supporting Cast £250 - £699 A YEAR
Leading Role £700 - £1,399 A YEAR
Headline Act £1,400 - £2,999 A YEAR
Hippodrome Circle £3,000+ A YEAR
Amount £ N.B. your contribution must be at least equal to the starting value of the Patron level you have selected
FROM
£2O5 NTH
Supporting Cast Patrons
AM
£250 - £699 ANNUALLY Or 10 instalments of a minimum of £25
Supporting Cast benefits include: • Advance show information • Priority booking and a personalised booking service • • Special ticket offers with no transaction charge or exchange fees • Access to sold out shows up to a week before • • Discounted dining in the Circle Restaurant, StageSide and the Deli Bar • • Three complimentary programme vouchers • Invitations to special Patrons events • • Accreditation in key publications •
NAME OF JOINT MEMBER (IF APPLICABLE):
Please include an additional donation of £
with my membership (PLEASE COMPLETE A GIFT AID MANDATE BELOW)
I wish to decline all benefits and make my total contribution a donation (PLEASE COMPLETE A GIFT AID MANDATE BELOW)
PAYMENT DETAILS Either
I wish to pay £
by ANNUAL Direct Debit (PLEASE COMPLETE FORM OVERLEAF).
or
I wish to pay £
in TEN INSTALMENTS by Direct Debit (PLEASE COMPLETE FORM OVERLEAF).
or
I enclose
by CHEQUE made payable to Birmingham Hippodrome.
or
I wish to pay £
£
by credit/debit card. Please call me on my contact number I have provided to take my payment details (please do not email credit or debit card details).
GIFT AID DECLARATION Your membership may qualify for Gift Aid, please sign below if you are eligible.
51,000 people attended free performances and events Data taken from our Performance Review, 2013-2014.
19,000 participants engaged with our Creative Learning Programme
1,400 attended access performances, talks or tours
14,000 discounted tickets were provided for school children
I would like Birmingham Hippodrome (Registered Charity number 511567) to treat all donations I have made since 6 April 2008 and all donations I make hereafter as Gift Aid donations, unless I notify you otherwise. I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year that is at least equal to the amount of tax that all charities I donate to will reclaim. I understand that other taxes such as VAT and Council Tax do not qualify. I confirm I will notify Birmingham Hippodrome if I wish to cancel this declaration, if my name or address changes or if I no longer pay sufficient tax as described above.
SIGNATURE:
DATE: