Your details Gift membership
Application form
I wish to purchase [3 tick as required]
Single full membership £18 Single discounted membership £15
Joint full membership £34 Joint discounted membership £28
Your details
Gift membership
Member 1
If you are purchasing membership as a gift for a friend or friends, please fill in the box opposite with your details and complete the recipient [s] details below:
Name Name 1
Address
Name 2 Address
Postcode Tel
Postcode
Email
Please indicate whether you wish to receive information via Post l Email [3 tick as required]
Member 2 [If joint membership required. Must be at same address]
Email
Please indicate whether you wish to receive information via Post l
Email [3 tick as required]
Please indicate whether you would like the membership card [s] sent to your address or the gift recipient [s] address
Name Email
Please indicate whether you wish to receive information via Post l
Tel
Email [3 tick as required]
Data Protection If you DO NOT wish to receive information by post please tick here If you DO NOT wish to receive information by email please tick here N.B. If you do not give your informed consent for mailing we will NOT be able to contact you regarding any events at Warwick Arts Centre.
Payment details [
3 tick as required]
I enclose a cheque for £ made payable to University of Warwick I wish to pay by debit/credit card and approve a telephone call from the box office. Please note preferred time to call:
FOR INTERNAL USE ONLY
I wish to pay by Direct Debit and have completed and signed the form opposite.
Instruction to your Instruction to your Bank or Building Society Bank or Building Society to Pay by Direct Debit to Pay by Direct Debit Instruction to your
etails
Please Please fill in the including official official use boxuse box fillwhole in the form whole form including using ausing ball point and send to: it to: a ballpen point pen andit send
Box Office, Box Office, Please fill in the whole form including official use box using a ball point pen and send it to: Warwick Arts yment Details Warwick Centre, Arts Centre, nd The University of Warwick, TheBox University of Warwick, Office, m Coventry, Warwick Arts Centre, Coventry, card and cheque for CV4 7AL CV4The 7ALUniversity of Warwick, all from
Coventry, note ble to: of Warwick Name(s)Name(s) of account holder(s) here: CV4 7ALfillholder(s) of account Please in the whole form including official use box using a ball point pen and send it to:
6
56
65
86
68
06
0
Service user number
6
5
6
8
6
0
FOR THE UNIVERSITY OF WARWICK OFFICIAL USE ONLY FOR THE UNIVERSITY OF WARWICK OFFICIAL USE ONLY
Instruction to your Bank orTHEBuilding Society FOR UNIVERSITY OF WARWICK OFFICIAL USE ONLY This is not part of the instruction to your bank or building society to Pay by Direct Debit
This is not part of the instruction to your bank or building society society This is not part of the instruction to your bank or building
Service user number
6
Name(s) of account holder(s) Box Office,
Warwick Arts Centre, ay by credit card and The University of Warwick, telephone call from and Coventry, ice. Please note Bank/building societysociety account number he Bank/building me to call CV4 7ALaccount number Debit andhere:
gned the
Bank or Building Society to Pay by Direct Debit
ServiceService user number user number
5
6
8
6
0
FOR THE UNIVERSITY OF WARWICK OFFICIAL USE ONLY This is not part of the instruction to your bank or building society
Bank/building society account number Name(s) of account holder(s)
OT ert Branch sort code ents NOT Branch sort code
Instruction to yourtobank building societysociety Instruction youror bank or building Please Please pay thepay University of Warwick Direct Debits from from the University of Warwick Direct Debits Instruction to your bank or building society the account detailed in this Instruction subjectsubject to the to the the account detailed in this Instruction Please pay the University of Warwick Direct Debits from 3 concert safeguards assured by theinby Direct Debit ay by Direct Debit andBranch sort code safeguards assured the DirectGuarantee. Debit Guarantee. the account detailed this Instruction subject to the leted and signed the I understand that assured this Instruction may Debit remain with with Bank/building society account number I understand that this Instruction may remain safeguards by the Direct Guarantee. site. the University of Warwick and, if and, so, details will be Ithe understand that Instruction may remain with University ofthis Warwick if so, details will be Name and fulland postal of your of bank orbank building societysociety Name full address postal address your or building passed electronically to my bank/building society. the University of Warwick and, if so, details willsociety. be Debit payments NOT Instruction to electronically your bank or building society passed to my bank/building tions Name and full postal address of your bank or building Bank/building society society The Manager Bank/building society Please To: The Manager pay theelectronically University of Warwick Debits fromsociety. passed to my Direct bank/building lessTo: than 3 concert Branch sort code sorn bookings. Bank/building society the account detailed in this Instruction subject to the To: The Manager
nable. erts her concerts and Conditions her
safeguards assured by the Direct Debit Guarantee. Signature(s) Signature(s)
Name and full postal address of your bank or building society
or any other Address Address scriptions Address To: The Manager
bscription ms are not returnable.
exchanged for other concerts
ed by but notbyfor any other series, der received Address essed are processed not apply to subscription ceived, Reference Reference onto is given to Reference en
Bank/building society
PostcodePostcode Postcode
Postcode
I understand that this Instruction may remain with Signature(s) the University of Warwick and, if so, details will be passed electronically to my bank/building society.
DateSignature(s) Date Date
Date
king forms in order received by nd subscriptions are processed which they are received, ers choosing sing Reference y seating allocation is given to given to those hose Subscribers. certs. multiple subscribers choosing Banks and building societies may not Direct acceptDebit Direct Debit Instructions for some typesaccount of account building societies may notmay accept for some ate subscribers Banks and building societies not accept DirectInstructions Debit Instructions fortypes someof types of account , priority will be given to those Banks and ribers we of concerts. rsted number Banks and building societies may not accept Direct Debit Instructions for some types of account kers. to allocate subscribers deavour This guarantee should be detached and retained by the payer. they have requested we This guarantee should should be detached and retained by the payer. This guarantee be detached and retained by the payer. ated from ee this for all bookers. m This guarantee should be detached and retained by the payer. kets will be allocated from
The Direct Debit TheThe Direct Debit Direct Debit The Direct Debit Guarantee Guarantee Guarantee Guarantee
od on 28 June, be booking received June, rity period on 28 June, ription iptionsforms are can be received ved Under subscriptions are sreare 26s allocated 1there July and is atickets are allocated cated ble basis, unless there is a • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits seated near to• another • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits artotobeanother • If there are any changes to the amount, date or frequency of your Direct Debit the University of Warwick will notify you This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits • If there are any changes to the amount, date or frequency of your Direct Debit the University of Warwick will notify you
scriber. her • If there are any changes to the amount, date or frequency of your Direct Debit the University of Warwick normally 10 working days in advance of your account being debited or as otherwise agreed. If you request the University normally 10 working days in advance of your account being debited or as otherwise agreed. If you request the University will notify you ketstowill be from posted to from • youIf there are any changes to the amount, date or frequency of your Direct Debit the University of Warwick will notify you ed you of Warwick to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
of Warwick to collect a payment, confirmation of the amount and date will be given to you at the time of the request. normally 10 working days in advance of your account being debited or as otherwise agreed. If you request the University normally 10 working days in advance of your account being debited or as otherwise agreed. If you request the University entitled to a full and immediate refund of the amount paid from your bank or building society – If you receive a refund you are 8 August entitled to a full and immediate refund of the amount paid from your bank or building society – If you receive a refund you are not entitled to, you must pay it back when the University of Warwick asks you to. y Subscribers for subsequent • If an error is made in the payment of your Direct Debit, by the University of Warwick or your bank or building society, you are • If an error is made in the payment of your Direct Debit, by the University of Warwick or your bank or building society, you are not entitled to, you must pay it back when the University of Warwick asks you to. tsubsequent • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be 2011/12 Series are subject to entitledentitled to a fullto and immediate refund of the amount paid from your bank orbank building societysociety – If you –receive a refunda you areyou are a full and immediate refund of the amount paid from your or building If you receive refund required. Please also notify us. andsubject conditions. • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be are to not entitled to, you must pay it back when the University of Warwick asks you to. not entitled to, you must pay it back when the University of Warwick asks you to. required. Please also notify us. ent • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be ct to • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us. required. Please also notify us.
• If an error is made in the payment of your Direct Debit, by the University of Warwick or your bank or building society, you are from ng opens onof Warwick to collect a payment, confirmation of the amount and date will be given to you at the time of the request. Mon 8 August • If an error is made in the payment of your Direct Debit, by the University of Warwick or your bank or building society, you are of Warwick to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
I wish to purchase [3 tick as required]
Single full membership £18 Single discounted membership £15
Joint full membership £34 Joint discounted membership £28
Your details
Gift membership
Member 1
If you are purchasing membership as a gift for a friend or friends, please fill in the box opposite with your details and complete the recipient [s] details below:
Name Name 1
Address
Name 2 Address
Postcode Tel
Postcode
Please indicate whether you wish to receive information via Post l Email [3 tick as required]
Member 2 [If joint membership required. Must be at same address]
Please indicate whether you wish to receive information via Post l
Email [3 tick as required]
Please indicate whether you would like the membership card [s] sent to your address or the gift recipient [s] address
Name Email
Please indicate whether you wish to receive information via Post l
Tel
Email [3 tick as required]
Data Protection If you DO NOT wish to receive information by post please tick here If you DO NOT wish to receive information by email please tick here N.B. If you do not give your informed consent for mailing we will NOT be able to contact you regarding any events at Warwick Arts Centre.
Payment details [
3 tick as required]
I enclose a cheque for £ made payable to University of Warwick I wish to pay by debit/credit card and approve a telephone call from the box office. Please note preferred time to call:
FOR INTERNAL USE ONLY
I wish to pay by Direct Debit and have completed and signed the form opposite.
Instruction to your Instruction to your Bank or Building Society Bank or Building Society to Pay by Direct Debit to Pay by Direct Debit Instruction to your
etails
Please Please fill in the including official official use boxuse box fillwhole in the form whole form including using ausing ball point and send to: it to: a ballpen point pen andit send
Box Office, Box Office, Please fill in the whole form including official use box using a ball point pen and send it to: Warwick Arts yment Details Warwick Centre, Arts Centre, nd The University of Warwick, TheBox University of Warwick, Office, m Coventry, Warwick Arts Centre, Coventry, card and cheque for CV4 7AL CV4The 7ALUniversity of Warwick, all from
Coventry, note ble to: of Warwick Name(s)Name(s) of account holder(s) here: CV4 7ALfillholder(s) of account Please in the whole form including official use box using a ball point pen and send it to:
6
56
65
86
68
06
0
Service user number
6
5
6
8
6
0
FOR THE UNIVERSITY OF WARWICK OFFICIAL USE ONLY FOR THE UNIVERSITY OF WARWICK OFFICIAL USE ONLY
Instruction to your Bank orTHEBuilding Society FOR UNIVERSITY OF WARWICK OFFICIAL USE ONLY This is not part of the instruction to your bank or building society to Pay by Direct Debit
This is not part of the instruction to your bank or building society society This is not part of the instruction to your bank or building
Service user number
6
Name(s) of account holder(s) Box Office,
Warwick Arts Centre, ay by credit card and The University of Warwick, telephone call from and Coventry, ice. Please note Bank/building societysociety account number he Bank/building me to call CV4 7ALaccount number Debit andhere:
gned the
Bank or Building Society to Pay by Direct Debit
ServiceService user number user number
5
6
8
6
0
FOR THE UNIVERSITY OF WARWICK OFFICIAL USE ONLY This is not part of the instruction to your bank or building society
Bank/building society account number Name(s) of account holder(s)
OT ert Branch sort code ents NOT Branch sort code
Instruction to yourtobank building societysociety Instruction youror bank or building Please Please pay thepay University of Warwick Direct Debits from from the University of Warwick Direct Debits Instruction to your bank or building society the account detailed in this Instruction subjectsubject to the to the the account detailed in this Instruction Please pay the University of Warwick Direct Debits from 3 concert safeguards assured by theinby Direct Debit ay by Direct Debit andBranch sort code safeguards assured the DirectGuarantee. Debit Guarantee. the account detailed this Instruction subject to the leted and signed the I understand that assured this Instruction may Debit remain with with Bank/building society account number I understand that this Instruction may remain safeguards by the Direct Guarantee. site. the University of Warwick and, if and, so, details will be Ithe understand that Instruction may remain with University ofthis Warwick if so, details will be Name and fulland postal of your of bank orbank building societysociety Name full address postal address your or building passed electronically to my bank/building society. the University of Warwick and, if so, details willsociety. be Debit payments NOT Instruction to electronically your bank or building society passed to my bank/building tions Name and full postal address of your bank or building Bank/building society society The Manager Bank/building society Please To: The Manager pay theelectronically University of Warwick Debits fromsociety. passed to my Direct bank/building lessTo: than 3 concert Branch sort code sorn bookings. Bank/building society the account detailed in this Instruction subject to the To: The Manager
nable. erts her concerts and Conditions her
safeguards assured by the Direct Debit Guarantee. Signature(s) Signature(s)
Name and full postal address of your bank or building society
or any other Address Address scriptions Address To: The Manager
bscription ms are not returnable.
exchanged for other concerts
ed by but notbyfor any other series, der received Address essed are processed not apply to subscription ceived, Reference Reference onto is given to Reference en
Bank/building society
PostcodePostcode Postcode
Postcode
I understand that this Instruction may remain with Signature(s) the University of Warwick and, if so, details will be passed electronically to my bank/building society.
DateSignature(s) Date Date
Date
king forms in order received by nd subscriptions are processed which they are received, ers choosing sing Reference y seating allocation is given to given to those hose Subscribers. certs. multiple subscribers choosing Banks and building societies may not Direct acceptDebit Direct Debit Instructions for some typesaccount of account building societies may notmay accept for some ate subscribers Banks and building societies not accept DirectInstructions Debit Instructions fortypes someof types of account , priority will be given to those Banks and ribers we of concerts. rsted number Banks and building societies may not accept Direct Debit Instructions for some types of account kers. to allocate subscribers deavour This guarantee should be detached and retained by the payer. they have requested we This guarantee should should be detached and retained by the payer. This guarantee be detached and retained by the payer. ated from ee this for all bookers. m This guarantee should be detached and retained by the payer. kets will be allocated from
The Direct Debit TheThe Direct Debit Direct Debit The Direct Debit Guarantee Guarantee Guarantee Guarantee
od on 28 June, be booking received June, rity period on 28 June, ription iptionsforms are can be received ved Under subscriptions are sreare 26s allocated 1there July and is atickets are allocated cated ble basis, unless there is a • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits seated near to• another • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits artotobeanother • If there are any changes to the amount, date or frequency of your Direct Debit the University of Warwick will notify you This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits • If there are any changes to the amount, date or frequency of your Direct Debit the University of Warwick will notify you
scriber. her • If there are any changes to the amount, date or frequency of your Direct Debit the University of Warwick normally 10 working days in advance of your account being debited or as otherwise agreed. If you request the University normally 10 working days in advance of your account being debited or as otherwise agreed. If you request the University will notify you ketstowill be from posted to from • youIf there are any changes to the amount, date or frequency of your Direct Debit the University of Warwick will notify you ed you of Warwick to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
of Warwick to collect a payment, confirmation of the amount and date will be given to you at the time of the request. normally 10 working days in advance of your account being debited or as otherwise agreed. If you request the University normally 10 working days in advance of your account being debited or as otherwise agreed. If you request the University entitled to a full and immediate refund of the amount paid from your bank or building society – If you receive a refund you are 8 August entitled to a full and immediate refund of the amount paid from your bank or building society – If you receive a refund you are not entitled to, you must pay it back when the University of Warwick asks you to. y Subscribers for subsequent • If an error is made in the payment of your Direct Debit, by the University of Warwick or your bank or building society, you are • If an error is made in the payment of your Direct Debit, by the University of Warwick or your bank or building society, you are not entitled to, you must pay it back when the University of Warwick asks you to. tsubsequent • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be 2011/12 Series are subject to entitledentitled to a fullto and immediate refund of the amount paid from your bank orbank building societysociety – If you –receive a refunda you areyou are a full and immediate refund of the amount paid from your or building If you receive refund required. Please also notify us. andsubject conditions. • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be are to not entitled to, you must pay it back when the University of Warwick asks you to. not entitled to, you must pay it back when the University of Warwick asks you to. required. Please also notify us. ent • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be ct to • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us. required. Please also notify us.
• If an error is made in the payment of your Direct Debit, by the University of Warwick or your bank or building society, you are from ng opens onof Warwick to collect a payment, confirmation of the amount and date will be given to you at the time of the request. Mon 8 August • If an error is made in the payment of your Direct Debit, by the University of Warwick or your bank or building society, you are of Warwick to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
