Name .......................................... Address ...................................................
Town ........................................................ Post Code .......................................
Telephone number ....................... Email .................................................

* Please print in BLOCK CAPITALS and list names of all Season or Patrons ticket holders separately.

The information you provide will be held securely on computer for our records only. We will not share your data with anyone else.
If you would like any donations (including the additional part of a Patrons ticket) to qualify for Gift Aid please tick (.....) to confirm your agreement. You must pay income or capital gains tax equal to the amount that can be reclaimed on your gift.

Print off, enclose a cheque made payable to Amersham Concert Club, a stamped, self-addressed envelope, and send to: Clive Morley, 1 Meadow Drive, Amersham, Bucks. HP6 6LB
(Tickets are also available by visiting Perfect Pitch in Chesham or The Record Shop, Woodside Road, Amersham.
Alternatively tickets may be reserved by applying to the >Box Office<)

Thank you. We look forward to seeing you at a concert.