Curzon 2012 Calendar Application Form
Please complete, print and sign this form, and send it with your payment to:
The Curzon Community Cinema, 46 Old Church Road, Clevedon, North Somerset, BS21 6NN
Name(s)
Address

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Telephone (optional)
Please send me
(number)  Curzon Centenary 2012 calendar(s) @ £2.50 each + £2 p&p
Note: £2 p&p only required for the first calendar in each mailing
Total enclosed £   Signed __________________________  Date _____________
Where to send the calendar(s) (if different to details above)
Name(s)
Address

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Message (optional)