Membership application

Name

Email Address

Phone

Postal address

Type of membership (please select) Type of membership (please select)Family $30Individual $20Concession/Child $10

Please list family members (max 4)

I want to be involved: I want to be involved: acting, directing supporting productions committees other

Agreement Agreement I support the purpose of the Beechworth Theatre Company Inc and agree to abide by the Rules of the Association