Third Age Registration Form

NAME: .......................................................................................................................................................

ADDRESS: .................................................................................................................................................

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

DATE OF BIRTH:..........................................................................................................................................

CONTACT TELEPHONE:...............................................................................................................................

DO YOU HAVE ACCESS TO PUBLIC TRANSPORT?.......................................................................................

DO YOU REQUIRE TRANSPORT ORGANISED FOR YOU?.............................................................................

PLEASE EXPLAIN.........................................................................................................................................
DO YOU HAVE ANY SPECIAL NEEDS?.........................................................................................................

IDEAS FOR FUTURE EVENTS......................................................................................................................

Would you be interested in becoming more involved in planning and choosing future events and performances?......

DATA BASE: The Maltings is a registered data controller under the Data Protection Act 1998. We may occasionally analyse the information provided, so that we may understand our customers better. By signing below, you are indicating that you consent to your data being analysed and to being sent information about the Maltings programmes and activities, by mail and email.

Signature........................................

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The Maltings Theatre & Arts Centre / Berwick-upon-Tweed / Northumberland TD15 1AJ / 01289 330999