Film Society Inc.
Membership form. 2004 Season
Print out this form and bring it to a screening or mail with a cheque to P.O. Box 484, Queenstown.
Please print clearly and ensure that you sign the form.
I hereby apply to join the Film Society Inc.
First Name: _______________________ Family Name: _______________________
Email address: ________________________________
Phone number (& fax) ___________________________
2004 Subscription ~ Full year fee is
Half year $60.00 single membership [ ]
Three film sampler (three films total) $25.00 single membership [ ]
Single members - shall be those persons being not less than seventeen (17) years of age, who have applied for such membership on the prescribed form and have paid the requisite subscription.
Membership Number: _______________ Cheque [ ] Cash [ ] amount: ________