FRIENDS OF THE WURLITZER MEMBERSHIP FORM

Annual membership for New Zealand residents is NZD $15.00. (Membership for residents of Australia is NZD $25.00 and NZD $30.00 for residents of the USA and UK).

We have two options available –

A) a normal subscription OR…….

B) a yearly “Season Ticket” which includes membership & seats to all the Wurlitzer Shows. (Only available at the start of each year)

OPTION A:
NORMAL SUBSCRIPTION = NZ $.........

Donation = NZ $.........

TOTAL Cheque = NZ $......... ………………..OR

OPTION B: *Please phone 525-7067 for seat allocation first

SEASON TICKET = NZ $ 140.00

Donation = NZ $........

TOTAL Cheque = NZ $........

PLEASE ADD MY NAME TO THE FRIENDS OF THE WURLITZER MAILING LIST.

ENCLOSED IS MY CHEQUE MADE PAYABLE TO THE WURLITZER ORGAN TRUST OF AUCKLAND.

MR / MRS / MISS / MS ___________________________________

ADDRESS: _______________________________________________

________________________________________________________

PHONE: ________________________________________________

EMAIL: ________________________________________________

PLEASE PRINT OUT AND MAIL IN THIS FORM, TOGETHER WITH YOUR CHEQUE, TO

FOTW MEMBERSHIP SECRETARY

C/- 39 GOLFLAND DR

GOLFLANDS

MANUKAU 2013

NEW ZEALAND

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Under the Privacy Act, we must advise you that the information you have given above will be treated as confidential and will only be used for events involving the Hollywood Theatre and the Wurlitzer Organ Trust of Auckland. Your details will not be supplied to any other group your organization without your prior consent.

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