Early Dance Circle
Registered Charity No. 1097746

Membership Application Form
from 1st January, 2004

 

To: Barbara Segal (Membership Secretary) 
3 Thornhill Square 
Islington 
London, N1 1BQ 
UK

 

Name: ……………………………………….….

Address: …………………………………………..

……………………………………….….

…………………………………………..

……………… Post Code …………….

Tel. no. …………………………………………..

e-mail: …………………………………………..

Type of membership required (please tick)

Full	£17.50	ڤ
Associate	£10.00	ڤ
Couple	£27.50	ڤ
Group (up to 10)	£80.00	ڤ
Additional members (beyond the original ten)	can be added at  £5.00 a head	ڤ

I enclose a cheque for £………………      
(made payable to - Early Dance Circle)

Foreign payments should be made in £ sterling, free of all charges to the recipient, e.g. by Post Office Giro, International Money Order or Bankers’ Draft.