Freepost 3322, Membership Secretary,
Wellington Film Society, P O Box 1584,
Wellington 6140

Or bring it along before any screening.   Please print clearly

Surname(s)_______________________________________________ Initials________________

Address________________________________________________________________________

_________________________________________________________ Post Code____________

Phone (Day)______________________________ (Evening) ______________________________

E-mail address__________________________________________________________________
(Used for sending e-mail newsletters or last minute screening information to members. PRINT CLEARLY)

Signature(s)_____________________________________________________________________

Member(s) last year? yes / no ,   If 'yes' write card no. here _______ ,   Address changed? yes / no

2008 Membership rates. Tick which applies. All prices include GST.

Single Season $90 , Double Season $160 , Discounted Season $80 ,

Youth Member $50 , Three Film Sampler $30 , Plus Voluntary Donation $......... .

Conditions: (Membership runs for twelve months from the month of joining)
*Double Season membership is available for any two people at the same address - both names required.
*Discounted Season is for students, Friends of the Film Archive, Radio Active 89FM Card holders,
  senior citizens & registered beneficiaries (with ID).
*Youth Member is anyone 16 years and younger (not available where censorship is restricted to higher age).
*The 3 Film Sampler gives access to any 3 films, but no benefits at the annual Wellington Film Festival. The 3 Film
  Sampler is valid only in the year of issue and is upgradeable to full membership. Lost cards will not be replaced
*All memberships are non-transferable. Membership entitles free entry to all Film Society screenings.
______________________________________________________________________________

Cheque, I enclose $_________________ Name on Cheque _____________________________

Bank_________________________________ Branch _________________________________
______________________________________________________________________________

Credit Card - Fill in ONLY if joining by mail. Allow two weeks for processing.

Charge my Visa , Bankcard , Mastercard .

Card Number _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ Valid to _ _ /_ _

Name on Card____________________________ Signature _____________________________

In accordance with the Privacy Act 1993, we advise members that we will maintain on file your name and
address as used in mailing Cinephile to you. You are welcome to access and correct such information by
writing to the Society or enquiring at our screenings. If you do not wish to receive advice on other film
related events which the committee may decide to share with our members from time to time, let us know.
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Office Use Only:   Amount Received $__________________   Date ___ /___ /2008.

Membership Number   _______________________________   Discount Coupon: yes / no
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