Early Dance Circle
Registered Charity No. 1097746

Membership Application Form
from 1st January, 2004

 

To: Barbara Segal (Membership Secretary) 
3 Thornhill Square 
Islington 
London, N1 1BQ 
UK

 

Name: ……………………………………….….

Address: …………………………………………..

……………………………………….….

…………………………………………..

……………… Post Code …………….

Tel. no. …………………………………………..

e-mail: …………………………………………..

Type of membership required (please tick)

Full	£20.00
Associate	£12.50
Couple	£30.00
Group (up to 10)	£80.00
Additional members (beyond the original ten)	can be added at  £5.00 a head

I enclose a cheque for £………………      
(made payable to - Early Dance Circle)

Foreign payments should be made in £ sterling, free of all charges to the recipient, e.g. by Post Office Giro, International Money Order or Bankers’ Draft.

Print the form above and return to: 
Barbara Segal, 3 Thornhill Square, Islington, London N1 1BQ, UK.