Membership Form

Membership Options

Single Youth $20, 10-18 years inclusive

Single Adult $25, over 18 years

Two or More Youths $40

Family $50, two adults at the same address + unlimited youth
Additional Adults $20 each; Additional adults over 18 years living at same address as “Family”

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MEMBER 1

Full Name

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Address

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Phone Number

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Cell Phone

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Please specify:

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Do you have:

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MEMBER 2

If not applicable go to the next page

Full Name

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Invalid email address.

Address

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Phone Number

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Cell Phone

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Please specify:

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MEMBER 3

If not applicable go to the next page

Full Name

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Invalid email address.

Address

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Phone Number

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Cell Phone

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Please specify:

AdultYouth Invalid Input

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MEMBER 4

If not applicable go to the next page

Full Name

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Invalid email address.

Address

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Phone Number

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Cell Phone

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Please specify:

AdultYouth Invalid Input

Do you have:

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EMERGENCY CONTACT

Emergency Contact Name

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Emergency Contact Relationship

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Phone

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Emergency Contact Email

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MEDICAL

Are there any medical condition/allergies that we should be aware of for anyone listed on this form?

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If yes, please explain which member and what:

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ADDITIONAL INFORMATION

I agree to be contacted via phone, email, or mail by Georgetown Little Theatre.

I agree to abide by the Code of Conduct.

I agree that my contact info (or that of my dependent(s) listed on this form), may be released to other members of the organization for GLT purposes. All personal contact info will be kept in strict confidence within the boundary of GLT business and will not be released to Third Parties outside of our organization.

I consent to photos and/or videos of myself and my family for the purpose of GLT publicity and advertising.

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PAYMENT

Would you like a tax receipt?

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Name on Tax receipt

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Membership Fee

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Pay for additional members

Family Membership - for additional adults pay $20 each. Additional adults over 18 years of age, living at the same address as “Family”

Additional Memberships Fee (add amount for all additional members)

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Processing Fee

Processing Fee - 2.00 CAD

Total

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Choose payment

Credit Card Payment

Cheque

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CHEQUE AND E-TRANSFERS

Cheques – Payable to “Georgetown Little Theatre Productions Inc”

Mail to:
Georgetown Little Theatre
33 Strewarttown Road
Georgetown, ON L7G 4S5

E-transfers
Send payment to membership@georgetownlittletheatre.ca and iInclude Members names on the message of the e-transfer – funds will be auto-deposited to GLT’s bank account.

ADDITIONAL YOUTH MEMBERSHIP INFORMATION

Youth 1

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Age

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Grade

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Youth 2

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Age

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Grade

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Youth 3

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Age

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Grade

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MEMBER 1

MEMBER 2

MEMBER 3

MEMBER 4

EMERGENCY CONTACT

MEDICAL

ADDITIONAL INFORMATION

PAYMENT

Pay for additional members

CHEQUE AND E-TRANSFERS

ADDITIONAL YOUTH MEMBERSHIP INFORMATION

Get Involved

Georgetown Little Theatre Patrons

2023-2024 Season

Diamond ($750 +)

Platinum ($500 - $749)

Gold ($250 - $499)

Silver ($150 - $249)

Bronze ($50 - $149)

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