Use this form template_pub (Read-Only)

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Please complete this form with your contact details First Name: _________________________________

Surname: ______________________________

Address: ____________________________________________________________________________ ___________________________________________________________

Postcode: ________________

Email ________________________________________________________________________________ (If applicable) Mobile ________________________

Home Tel _________________________

Learning Difficulties/Disabilities/Health Do you consider yourself to have a disability, health problem or learning difficulty? Please supply details overleaf

Yes/No ________

Data Protection Are you happy to be contacted by the following means: PHONE Yes / No

TEXT Yes / No

POST Yes / No

EMAIL Yes / No

Please note your information will be held on file in accordance with our Data Protection Policy, see Terms and Conditions online

Consent - To be completed by ALL participants I consent to the above named person receiving medical emergency treatment if necessary Yes / No I consent to the above named person being photographed/filmed where appropriate by NTR for general press/publicity purposes.

Yes / No

I consent to the above named person being photographed/filmed where appropriate by NTR for use on social media.

Yes / No

Booking I would like to book …….. spaces on the ‘Northern Ballet’s Casanova workshop on Thursday 6th April 2017 from 9.15am – 10.45am.




I have paid by £19.50 by cheque made out to Norwich Theatre Royal I have paid £19.50 by card at Stage Two reception I have paid £19.50 by cash at Stage Two reception

Alternatively please return this form (and payment) to this freepost address: Freepost RTJG - ASAE - ZLA, Education Department, Theatre Royal, Theatre Street, Norwich, Norfolk, NR2 1RL


I have enclosed a cheque (£19.50) made out to Norwich Theatre Royal

Norwich Theatre Royal’s Education Department work is generously supported by trusts and foundations including The Chivers Trust, Geoffrey Watling Charity, The John Jarrold Trust, Town Close Charitale Trust, Garfield Weston Foundation, Ernest Cook Trust, The Norfolk Opera Trust, The Paul Bassham Trust, Arts Council England and the Norwich Theatre Royal Ambassadors. In addition, we receive sponsorship from local businesses including, White Label Media, InTouch Systems, Hollinger Print and Julian Claxton Photography. Norwich Theatre Royal is a Registered Charity: No 262259