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Medina Theatre - APPLICATION FORM

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Medina Theatre - APPLICATION FORM
Fairlee Road Newport Isle of Wight PO30 2DX
Tel : 01983-527020 ~ Fax : 01983-822821
Application form for hire of Medina theatre - This form must be taken to the theatre box office to be completed along with the Statement of Cost for Private Hire of Medina Theate form.
NOTE: Completion of both forms does not confirm booking.
Organisation
* Name of organisation
Registered charity no.
(if applicable)
Contact Name
* Forename
Middle name/Initials
* Surname
 
Address
* Building/house name/number
 
* Street address
 
* Town name
 
County
* Postcode
 
 Tel number
(include area code)
Mobile number
Email address  
Fax

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