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Cinema Season Membership Application Form Name: _________________________________________ Address:

_________________________________________ _________________________________________ _________________________________________

Tel:__________________ Email:

_______________________

I would like to be added to the Nerve Centre email list to receive the latest news, events, offers and opportunities (please tick) <INPUT TYPE=\ CHECKBOX > MACROBUTTON HTMLDirect Season Pass Cost: £36 (NO REFUNDS under any circumstances) Please Note: An up-to-date photographic membership card must be shown at the Nerve Centre reception desk before each film screening. A Season Membership entitles you to entry to all screenings in the current cinema programme on a first come basis. Please note screenings are subject to change including cancelation or rescheduling. Please return completed form with a current passport photo to: Nerve Centre, 7-8 Magazine Street, Derry~Londonderry, BT48 6HJ. Tel:028 71260562. www.nervecentre.org ……………………………………………………………………………………….. For staff purposes only: Cinema Season Membership Card

Photo ID

Member Details: Name:

___________________

Address:

___________________ ___________________

Season:

03 Sept – 07 Nov 2012

Exp Date:

07 Nov 2012

Member Signature:

___________________


Please Sign here

Nerve Centre Cinema Membership  

Nerve Centre Cinema Seasonal Membership Application Form

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