Access Membership Form ਍倀氀攀愀猀攀 爀攀琀甀爀渀 琀栀攀 挀漀洀瀀氀攀琀攀搀 昀漀爀洀 戀礀 瀀漀猀琀 漀爀 戀礀 攀洀愀椀氀㨀ഀഀ Access, Marina Theatre, Marina, Lowestoft, NR32 1HH ਍椀渀昀漀䀀洀愀爀椀渀愀琀栀攀愀琀爀攀⸀挀漀⸀甀欀 ⠀昀漀爀洀猀 眀椀氀氀 渀攀攀搀 琀漀 戀攀 瀀爀椀渀琀攀搀Ⰰ 猀椀最渀攀搀 愀渀搀 猀挀愀渀渀攀搀⤀ഀഀ If you have any questions about the Access Membership scheme, or how to complete this form, please contact the Box Office on 01502 533200 or email info@marinatheatre.co.uk ਍䤀渀搀椀瘀椀搀甀愀氀 眀栀漀 栀愀猀 愀挀挀攀猀猀 爀攀焀甀椀爀攀洀攀渀琀猀㨀ഀഀ Name ______________________________________________________________ ਍䄀搀搀爀攀猀猀 开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开ഀഀ _________________________________________Postcode __________________ ਍吀攀氀攀瀀栀漀渀攀 一甀洀戀攀爀 开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开ഀഀ Mobile Number _____________________________________________________ ਍䔀洀愀椀氀 䄀搀搀爀攀猀猀 开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开ഀഀ Date of Birth (if under 16) _____________________________________________ ਍ഀഀ Please use my details to send me information about products, events, offers and ways in which I can support the Marina Theatre ਍ഀഀ ਍ഀഀ If we need to contact you directly about your order (such as booking reminders, feedback requests, or membership information) what’s the best way to contact you? ਍ഀഀ ਍ഀഀ By submitting this form you acknowledge that the data provided by you will be processed in accordance with the Marina Theatre privacy policy. This can be read at marinatheatre.co.uk/privacy-policy, or call 01502 533215 to be sent a copy. ਍䤀 挀漀渀猀攀渀琀 琀漀 琀栀攀 椀渀昀漀爀洀愀琀椀漀渀 瀀爀漀瘀椀搀攀搀 愀戀漀甀琀 洀礀 䄀挀挀攀猀猀 爀攀焀甀椀爀攀洀攀渀琀 戀攀椀渀最 愀搀搀攀搀 琀漀 琀栀攀 䴀愀爀椀渀愀 吀栀攀愀琀爀攀 搀愀琀愀戀愀猀攀 昀漀爀 琀栀攀 搀甀爀愀琀椀漀渀 漀昀 洀礀 洀攀洀戀攀爀猀栀椀瀀ഀഀ ਍匀椀最渀攀搀 开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开   䐀愀琀攀开开开开开开开开开开开开开开开开开开开开开开ഀഀ By Post ਍䈀礀 䔀洀愀椀氀ഀഀ By Email ਍䈀礀 吀攀氀攀瀀栀漀渀攀ഀഀ By Email ਍䈀礀 倀漀猀琀ഀഀ Ticket booker: ਍䤀昀 猀漀洀攀漀渀攀Ⰰ 漀渀 漀挀挀愀猀椀漀渀Ⰰ 戀漀漀欀猀 琀栀攀愀琀爀攀 琀椀挀欀攀琀猀 漀渀 礀漀甀爀 戀攀栀愀氀昀 ⠀昀愀洀椀氀礀⼀昀爀椀攀渀搀⼀最爀漀甀瀀 戀漀漀欀攀爀⤀Ⰰ 瀀氀攀愀猀攀 瀀爀漀瘀椀搀攀 甀猀 眀椀琀栀 琀栀攀椀爀 搀攀琀愀椀氀猀 戀攀氀漀眀⸀ 倀氀攀愀猀攀 挀漀渀琀椀渀甀攀 漀渀 愀 猀攀瀀愀爀愀琀攀 猀栀攀攀琀 椀昀 洀漀爀攀 琀栀愀渀 漀渀攀 瀀攀爀猀漀渀 戀漀漀欀猀 漀渀 礀漀甀爀 戀攀栀愀氀昀⸀ഀഀ Name ______________________________________________________________ ਍䄀搀搀爀攀猀猀 开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开ഀഀ _________________________________________Postcode __________________ ਍吀攀氀攀瀀栀漀渀攀 一甀洀戀攀爀 开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开ഀഀ Mobile Number _____________________________________________________ ਍䔀洀愀椀氀 䄀搀搀爀攀猀猀 开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开ഀഀ ਍倀氀攀愀猀攀 甀猀攀 琀栀攀 愀戀漀瘀攀 搀攀琀愀椀氀猀 琀漀 猀攀渀搀 琀栀攀 琀椀挀欀攀琀 戀漀漀欀攀爀 椀渀昀漀爀洀愀琀椀漀渀 愀戀漀甀琀 瀀爀漀搀甀挀琀椀漀渀猀Ⰰ 攀瘀攀渀琀猀Ⰰ 漀昀昀攀爀猀 愀渀搀 眀愀礀猀 琀栀攀礀 挀愀渀 猀甀瀀瀀漀爀琀 琀栀攀 䴀愀爀椀渀愀 吀栀攀愀琀爀攀ഀഀ ਍ഀഀ ਍䈀礀 猀甀戀洀椀琀琀椀渀最 琀栀椀猀 昀漀爀洀 礀漀甀 愀挀欀渀漀眀氀攀搀最攀 琀栀愀琀 琀栀攀 搀愀琀愀 瀀爀漀瘀椀搀攀搀 戀礀 礀漀甀 眀椀氀氀 戀攀 瀀爀漀挀攀猀猀攀搀 椀渀 愀挀挀漀爀搀愀渀挀攀 眀椀琀栀 琀栀攀 䴀愀爀椀渀愀 吀栀攀愀琀爀攀 瀀爀椀瘀愀挀礀 瀀漀氀椀挀礀⸀ 吀栀椀猀 挀愀渀 戀攀 爀攀愀搀 愀琀 洀愀爀椀渀愀琀栀攀愀琀爀攀⸀挀漀⸀甀欀⼀瀀爀椀瘀愀挀礀ⴀ瀀漀氀椀挀礀Ⰰ 漀爀 挀愀氀氀  ㄀㔀 ㈀ 㔀㌀㌀㈀㄀㔀 琀漀 戀攀 猀攀渀琀 愀 挀漀瀀礀⸀ഀഀ ਍夀漀甀 愀氀猀漀 挀漀渀昀椀爀洀 琀栀愀琀 琀栀攀 瀀攀爀猀漀渀 愀戀漀瘀攀 栀愀猀 最椀瘀攀渀 瀀攀爀洀椀猀猀椀漀渀 昀漀爀 礀漀甀 琀漀 猀栀愀爀攀 琀栀攀椀爀 椀渀昀漀爀洀愀琀椀漀渀⸀ഀഀ ਍匀椀最渀攀搀 开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开   䐀愀琀攀开开开开开开开开开开开开开开开开开开开开开开ഀഀ Don’t Send ਍䐀漀渀ᤀ琠 匀攀渀搀ഀഀ Seating ਍嘀椀猀甀愀氀氀礀 䤀洀瀀愀椀爀攀搀ഀഀ I require a Wheelchair Space ਍ഀഀ I would like to attend Touch Tours ਍ഀഀ I would like to borrow a Wheelchair for my visit ਍ഀഀ I would like to bring my Guide Dog to the performance ਍ഀഀ I require an Aisle seat ਍ഀഀ I require a Large Print season brochure ਍ഀഀ I require Step Free access to ਍洀礀 猀攀愀琀ഀഀ ਍ഀഀ ਍䤀 爀攀焀甀椀爀攀 愀 猀攀愀琀 挀氀漀猀攀 琀漀 愀渀 䔀砀椀琀ഀഀ ਍ഀഀ ਍䤀 爀攀焀甀椀爀攀 愀 猀攀愀琀 挀氀漀猀攀 琀漀 琀栀攀 䄀挀挀攀猀猀椀戀氀攀 吀漀椀氀攀琀 ഀഀ ਍ഀഀ ਍䠀攀愀爀椀渀最 䤀洀瀀愀椀爀攀搀ഀഀ I would be interested in attending a British Sign Language performance ਍ഀഀ I prefer to attend Relaxed Performances ਍ഀഀ I require a Sennheiser Infrared Hearing System unit ਍ഀഀ I would like to bring my Assistance Dog (not Guide Dog) to the performance ਍ഀഀ ਍ഀഀ I am on the Autism Spectrum or have a Sensory or Communication Disorder or Learning Disability ਍ഀഀ ਍ഀഀ I am living with Dementia ਍ഀഀ ਍ഀഀ I have no specific needs ਍ഀഀ Other ਍ﰀഀഀ ü ਍ﰀഀഀ ü ਍䤀 渀攀攀搀 攀猀猀攀渀琀椀愀氀 愀猀猀椀猀琀愀渀挀攀 搀甀爀椀渀最 洀礀 瘀椀猀椀琀 椀渀 漀爀搀攀爀 琀漀 昀甀氀氀 ഀഀ enjoy my visit to the Marina Theatre ਍夀漀甀爀 䄀挀挀攀猀猀 刀攀焀甀椀爀攀洀攀渀琀猀㨀 ⠀瀀氀攀愀猀攀 琀椀挀欀 愀氀氀 琀栀愀琀 愀瀀瀀氀礀⤀ഀഀ Remember to let us know if any of these change ਍倀爀攀ⴀ瘀椀猀椀琀猀㨀 圀攀 眀漀甀氀搀 戀攀 瘀攀爀礀 栀愀瀀瀀礀 昀漀爀 礀漀甀 琀漀 挀漀洀攀 椀渀 昀漀爀 愀 ᠀瀠爀攀ⴀ瘀椀猀椀琀ᤀ†猀漀 礀漀甀 挀愀渀 猀攀攀 眀栀愀琀 眀攀 挀愀渀 漀昀昀攀爀 愀渀搀 昀椀渀搀 漀甀琀 眀栀愀琀 眀漀爀欀猀 戀攀猀琀 昀漀爀 礀漀甀⸀ 䘀漀爀 洀漀爀攀 椀渀昀漀爀洀愀琀椀漀渀Ⰰ 漀爀 琀漀 戀漀漀欀 愀 瀀爀攀ⴀ瘀椀猀椀琀Ⰰ 瀀氀攀愀猀攀 挀愀氀氀  ㄀㔀 ㈀ 㔀㌀㌀㈀   漀爀 攀洀愀椀氀 椀渀昀漀䀀洀愀爀椀渀愀琀栀攀愀琀爀攀⸀挀漀⸀甀欀ഀഀ Essential Companion: ਍䤀昀 礀漀甀 爀攀焀甀椀爀攀 攀猀猀攀渀琀椀愀氀 愀猀猀椀猀琀愀渀挀攀 搀甀爀椀渀最 礀漀甀爀 瘀椀猀椀琀 椀渀 漀爀搀攀爀 琀漀 昀甀氀氀礀 攀渀樀漀礀 礀漀甀爀 琀椀洀攀 眀椀琀栀 甀猀Ⰰ 礀漀甀 洀愀礀 戀攀 攀氀椀最椀戀氀攀 昀漀爀 䔀猀猀攀渀琀椀愀氀 䌀漀洀瀀愀渀椀漀渀 吀椀挀欀攀琀猀⸀ 䔀猀猀攀渀琀椀愀氀 䌀漀洀瀀愀渀椀漀渀 攀氀椀最椀戀椀氀椀琀礀 愀氀氀漀眀猀 礀漀甀 琀漀 戀爀椀渀最 愀 挀漀洀瀀愀渀椀漀渀 眀椀琀栀 礀漀甀Ⰰ 昀爀攀攀 漀昀 挀栀愀爀最攀Ⰰ 椀昀 礀漀甀 昀攀攀氀 琀栀愀琀 礀漀甀 挀漀甀氀搀 渀漀琀 愀琀琀攀渀搀 眀椀琀栀漀甀琀 漀渀攀⸀ഀഀ Essential Companion status lasts for a 12month period. At the end of your 12month period you will need to re-apply. ਍ഀഀ ਍ഀഀ To qualify for Essential Companion tickets you must provide a photocopy of your most recent documentation. It must be dated within the last 12 months. On occasion we may ask to see the original document. ਍圀攀 愀挀挀攀瀀琀 琀栀攀 昀漀氀氀漀眀椀渀最㨀 ഀഀ Disability Living Allowance or Personal Independence Payment ਍䄀琀琀攀渀搀愀渀挀攀 䄀氀氀漀眀愀渀挀攀ഀഀ Certificate of Visual Impairment ਍䌀䔀䄀 䌀愀爀搀 漀爀 䐀椀猀愀戀椀氀椀琀礀 刀愀椀氀挀愀爀搀ഀഀ A Doctor’s letter ਍䌀愀爀攀爀猀 愀氀氀漀眀愀渀挀攀 漀昀 渀漀洀椀渀愀琀攀搀 挀愀爀攀爀ഀഀ Marina Theatre reserves the right to review and amend the scheme without prior notice and may require members to re-apply after the review. ਍䈀礀 倀漀猀琀ഀഀ Anything else, not covered above? (Use separate sheet if necessary) ਍开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开ഀഀ _____________________________________________________________________ ਍开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开ഀഀ _____________________________________________________________________ ਍䐀攀挀氀愀爀愀琀椀漀渀㨀ഀഀ Please sign below to confirm that the information provided in this form are true and correct to the best of your knowledge. Members who intentionally give false or misleading information will have their Access Membership revoked. ਍ഀഀ Signed ______________________________ Date______________________ ਍倀氀攀愀猀攀 爀攀琀甀爀渀 琀栀攀 挀漀洀瀀氀攀琀攀搀 昀漀爀洀 戀礀 瀀漀猀琀 漀爀 戀礀 攀洀愀椀氀㨀ഀഀ Access, Marina Theatre, Marina, Lowestoft, NR32 1HH ਍椀渀昀漀䀀洀愀爀椀渀愀琀栀攀愀琀爀攀⸀挀漀⸀甀欀 ⠀昀漀爀洀猀 眀椀氀氀 渀攀攀搀 琀漀 戀攀 瀀爀椀渀琀攀搀Ⰰ 猀椀最渀攀搀 愀渀搀 猀挀愀渀渀攀搀⤀ഀഀ ਍䤀昀 礀漀甀 栀愀瘀攀 愀渀礀 焀甀攀猀琀椀漀渀猀 愀戀漀甀琀 琀栀攀 䄀挀挀攀猀猀 䴀攀洀戀攀爀猀栀椀瀀 猀挀栀攀洀攀Ⰰ 漀爀 栀漀眀 琀漀 挀漀洀瀀氀攀琀攀 琀栀椀猀 昀漀爀洀Ⰰ 瀀氀攀愀猀攀 挀漀渀琀愀挀琀 琀栀攀 䈀漀砀 伀昀昀椀挀攀 漀渀  ㄀㔀 ㈀ 㔀㌀㌀㈀   漀爀 攀洀愀椀氀 椀渀昀漀䀀洀愀爀椀渀愀琀栀攀愀琀爀攀⸀挀漀⸀甀欀ഀഀ