Section 1: Your Details (Delete As Applicable)

Event

Event: / Dreamgirls
Venue: / Savoy Theatre, Strand, London WC2R 0ET
Date of event: / Tuesday 25 April 2017
Start time: / 7:30pm
Closing date for entries: / Tuesday 11 April 2017

Please complete all sections in BLOCK CAPITALS. CSSC membership numbers must be included. You may find it helpful to ‘Tab’ from one field to another.

Section 1: Your Details (Delete as applicable)

Title: / Forename: / Surname:
Gender: / Over 18: / Yes / No
Home Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.

Section 2: Advertising

Please indicate how you heard about the event:

Leisure Scene magazine / Other CSSC Event / Friend/Colleague
CSSC Website / Poster in the workplace / Departmental Intranet
Email

Section 3: Entry Fee

Please state how many members/non-members are attending this event.

If they are members please state the membership number and/or non-members please state the names below.

Name / CSSC number (if applicable) / Contact number / Email Address

CSSC Members: £25 Non-Members: £45

Payment can be made by BACs or by cheques.

Payment Method: / Total Amount: / £

Payment details for BACS or address for cheques will be provided by the organiser following your email to
Refund Policy: No refunds will be given after the closing date.

Section 4 : Event Information

Seats will be located in the stalls: S and Q

Section 5: Important Information

Medical: Please let us know if you have any physical or medical conditions

Yes/No (Delete as applicable)

IMPORTANT: These events are active and players should be aware of the physical activities involved. CSSC reserves the right to cancel the event if under subscribed.

All CSSC members taking part in the event are covered by CSSC Sports and Leisure Public Liability Insurance. Please note that this policy is NOT a Personal Accident Policy. Members are encouraged to take out their own insurance policy.

This event is open to your friends or family members. As a reminder, under our Linked membership scheme, up to three of your friends or family members can join CSSC and take part in our events at members’ rate. Membership is also available to staff working in the Public Sector such as NHS, local government, teachers, the police, fire fighters and HM Armed forces personnel.

Once entry forms and payment are received and processed an acknowledgement email will be sent out with further information a week before the event.

Any enquires directly linked to the event please contact Adam Hookway by email:

Signed: Date:

Please send all entries to:

Email: