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MAILING LIST / FRIENDS OF THE RIO / RIO APPEAL

PRINT OUT THIS PAGE AND FILL IN AS APPROPRIATE AND SEND TO THE ADDRESS BELOW.

Please tick as appropriate

• I would like to go on the mailing list and enclose £5

• I would like to make a donation to the Rio Appeal Fund of £______

• I would like to name a seat (min. donation £150)

• I would like to join the Friends of the Rio Annual  tick box £25     tick box Joint £40      tick box Life £200

• I enclose a cheque/postal order for £______ payable to the Rio Cinema

Name/s: .............................................................................................................................

Address: ............................................................................................................................

..........................................................................................................................................

Your postcode: .......................... E-mail: .............................................................................

I/we would like to receive the free Rio E-newsletter tick box
You do not need to tick this box if you are already an E-newsletter subscriber

Your phone no.: ..................................... Mobile no.: ...............................................
(Including area code)

Signature/s: ................................................................ Date: ..................................

I/we enclose a cheque/postal order payable to Rio Cinematick box

Alternatively, you can pay by credit or debit card using the form below:

NB This portion of the form will be detached and securely shredded once it has been processed.

Cardholder name: ................................................................................................

Card number: ......................................................................................................

Valid from: ............... Expiry date: .............. Issue number (Switch only): ......

CVV no.: ............................... Amount: £ ................

The CVV (or CV2) is the three digit number on your card's signature strip. (Or the last three digits of the number you find there.)

Cardholder's signature: .......................................................................................


Send to: Rio Cinema, 107 Kingsland High Street, London E8 2PB
The Rio Centre (Dalston) Ltd is a registered charity no. 277415