Send your completed Application Form to the Box Office, Civic Hall, High Street, Bedworth CV12 8NF or call the Box Office to join.

Application Form :

Name........................................................................

Address:...............................................................................................................................

Post Code:..................................................

Email:.................................................................................................................................
Tel:............................................................................................

Mobile:...................................................................................

Please enclose a cheque for £15 payable to Nuneaton and Bedworth Borough Council or debit my account (Visa, Mastercard, Switch, Maestro, Delta)

Name: ...............................................................

Card No: ...........................................................

Start Date: ........................................................

End Date: .........................................................

Issue No: ..........................................................

Signed: .............................................................

All Friends data collected will be used for Civic Hall, Bedworth purposes and kept for 12 months only. Data protection Act 1997 applies.