All fields marked with a * are required entries
Medina Theatre - Insurance/Indemnity Form
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Medina Theatre - Insurance/ Indemnity Form
Fairlee Road Newport Isle of Wight PO30 2DX
Tel : 01983-527020 - Fax : 01983-822821
This form must be completed and accompanied with the appropriate insurance documents.
Organisation
*
Name of organisation
Registered charity no.
(if applicable)
Your Details
*
Forename
Middle name/Initials
*
Surname
*
Building/house name/number
*
Street address
*
Town name
County
*
Postcode
Tel number
(include area code)
Email address
Fax
Fields marked '*' are required entries.
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