Opera Box Limited

The Friends of Opera Box Membership Application Form
Mr/Mrs/Miss/Ms	........................................
Mr/Mrs/Miss/Ms	........................................
Address	........................................ ........................................ ........................................
Postcode	........................................
Telephone	........................................

Please tick membership appropriate to you

Single	Ł15	Ł60
Family / Couple	Ł25	Ł100
Student	Ł10	Ł40

Additional donations will be very welcome!
	I enclose a cheque made payable to the Friends of Opera Box
	I have completed the Standing Order Mandate opposite
	I enclose a donation for Ł_______ made payable to the Friends of Opera Box but I do not wish to become a Friend
	I have completed a Gift Aid Declaration to enhance the value of my payment

The Friends of Opera Box Standing Order Mandate
Name of Bank	........................................
Postal Address	........................................ ........................................ ........................................
Please pay to the account of The Friends of Opera Box at LLoyds Bank The Square Market Harborough Leicestershire LE16 7PE Account No : 0215697 Sort Code : 30 95 47
The sum of	Ł........................................
Amount in words	..........................................
Commencing (date of first payment)	____/____/____
And thereafter on the same day each year until further notice in writing or until (date of final payment)	____/____/____
And debit my account :
TITLE	........................................
ACCOUNT NUMBER	........................................
SIGNATURE(S)	........................................
	........................................
DATE	____/____/____