

APPLICATION FORM
Please print your details in BLOCK LETTERS

Title (Mr/Mrs/Ms)
First Name
Last Name
Address
Suburb
Postcode ___________________________ State
Date of Birth __________/__________/__________
Phone email
I do not wish my personal information to be used by Greater Union or Birch Carroll & Coyle or any of its related entities for marketing purposes including the sending of quarterly Seniors Club newsletters and periodic special promotions for Seniors Club members.
CON DITION S OF MEMBERSHIP FOR THE SENIORS CLUB
★ Membership is open to patrons 60 years and over - identification is required
★ Discounted movie tickets are not available with any other coupon, voucher or offer
★ Membership Card must be presented to receive Seniors Club benefits
★ Greater Union and Birch Carroll & Coyle reserve the right to change the terms of the Seniors Club, including the price of movie tickets and the annual fee, at any time without notice
★ Membership is non-transferable
★ Lost or stolen Seniors Club membership cards cannot be replaced
★ Seniors Club membership includes regular newsletters and periodic promotions which will be sent to the postal or email address provided by you, unless you indicate otherwise on the application form
★ Membership is valid for one year from the date of joining or renewing
★ New memberships or renewals cannot be processed at Greater Union Blacktown and Bass Hill Drive-Ins or George Street Sydney
APPLICANT’S
I understand and accept the terms and conditions of the Seniors Club