The Playhouse 400 Club Seat Sponsorship Appeal Form

Name: ----------------------------------------

Address:------------------------------------------------------------------------------------------------------------------------------------------------

Daytime tel: ------------------------------------------------

Evening tel: ------------------------------------------------

e-mail: -------------------------------------------------

I would like to sponsor the following seat(s):* -----------------------------------------------* Please indicate Block, Row AND seat number(s) required (eg, Block A, Row A, Seat 1; Block E, Row P, Seats 14-16, etc)

Choose from the following payment methods:

I enclose a cheque (made payable to Harlow Council) for £ ---------------

Charge my Mastercard/Switch/Visa card number --------------------

Start date ----------------- Expiry date ----------------- Issue no (Switch only) -------------

I authorise you to debit my card account with the amount of £ -----------------------

Card holder’s signature -------------------------------

Would you like to be added to our mailing list?

Please print out and  complete form and then send to Philip Dale, Theatre Manager, The Playhouse, Playhouse Square, Harlow, Essex CM20 1LS. Thank you for your sponsorship!

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