Access Membership Registration with a Nominated Representative

Please complete the following section with the details of the representative who will act on behalf of the person named above.

Name*

First NameLast Name

Relationship to customer with access requirements*

Email Address*

example@example.com

Address*

Street Address

Street Address Line 2

Town/CityCounty

Post Code

Phone Number*

Please enter a valid phone number.Format: 00000 00000[0].

Does this person already have a customer account with Camberley Theatre?*

YesNo

Who is completing this form?*

I am the person named on the Access CardI am the Representative of the person named on the Access Card