Membership Application Form  (Please print this page)

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

Address..................................................................................

...............................................................................................

...............................................................................................

Telephone..............................................................................

E-mail...................................................................................

I wish to become a member of the Furness Theatre Organ Project and enclose an initial membership subscription of £10.

I would also like to give a donation of ............. (optional).

I would also like to offer practical help (optional).

.................................................................................................................................................

Please state above any areas of expertise such as building work, fundraising, electrical etc.

Signed...........................................................................

Date..............................................................................

Please print off form and send together with donation to:

The Furness Theatre Organ Project,

C/o 108 North Row,

Roose,

Barrow-in-Furness,

Cumbria.

LA13 0HQ

Cheques should be made payable to 'Furness Theatre Organ Project'