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: _______________________

Address: _____________________________________________________________

Email address: ________________________________

Phone number (& fax) ___________________________


Signature _____________________________________

2004 Subscription ~ Full year fee is

$105.00 single membership [ ]

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.

Official use:

Membership Number: _______________ Cheque [ ] Cash [ ] amount: ________

In accordance with the Privacy Act 1993, we advise members that we will maintain on file your name and address as used in mailing new season and special screening details to you. You are welcome to access and correct such information by writing to the Society or enquiring at our screenings. If you do not wish to receive advice on other film related events which the committee may decide to share with our members from time to time, let us know.