Friends of the Royal New Zealand Ballet Inc

Membership Form

Please post completed form and payment (if paying by cheque) to:

Friends of the Royal New Zealand Ballet, PO Box 27 050, Wellington

Title Mr/Mrs/Ms/Miss/Dr/Sir/Lady/First name (Please circle preferred title for address)

First Name ________________________ Surname _____________________________

Name & title of second person (for dble membership)_________________________

Address ________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Phone: Home __________________ Work _________________ Mobile _____________________

Email ___________________________________________________________________

Single membership $30.00_____________________________________ $___________

Double membership $40.00 (2 people at the same address)_________ $___________

10 year membership ($270 single, $360 double) ___________________ $___________

Perpetual membership (single) $1000 ___________________________ $___________

Gift membership (single/double) ________________________________$___________

Donation to help fund the dancers' shoes (tax deductible) __________$___________

Total ______________________________________________________$ _____________

Donations of $100 & over will erceive:

• Dance News
• Invitation to a Royal New Zealand Ballet annual social finction

Please note: All memberships are from 1 January to 31 December

Have you thought of a gift membership for a friend?

Name for gift membership _____________________________________________________________

Address for gift member _______________________________________________________________

___________________________________________________________________________

Where would you like your gift membership card sent?

To my address/to my gift member (cross out the one that does not apply)

Please post complete form and payment (if by cheque) to:

Friends of the Royal New Zealand Ballet

PO Box 27-050 Wellington 6141

Payment by Internet banking instructions

Our bank account number is : 030502 0019406 00

Our account name is : Friends of the Royal New Zealand Ballet

You must enter a Reference and Particulars for us to be able to match-up your payment and request:

In the Reference field enter your LAST NAME & INITIAL

In the Particulars field enter MEMBERSHIP

Payment by Credit Card

Card Number: ___________________________

Expiry Date: _______________

Name on card: ______________________________________

Signature: _______________________________________