AMICI DIRECTOR: WOLFGANG STANGE
For membership please,		and fill in your details below and return to:
Turtle Key Arts Ladbroke Hall 79 Barlby Road London W10 6AZ
NAME_____________________________________ Parent's / Carer's name (optional)___________________________________ DOB____/____/____      AGE______ ADDRESS ________________________________________________________________________ __________________________________POSTCODE__________________ PHONE NUMBER___________________ E-MAIL____________________________ Any special needs or requirements ________________________________________________________________________ ________________________________________________________________________ Interests (please circle) Dance                             Theatre                              Music Previous experience ________________________________________________________________________ ________________________________________________________________________ How did you hear about Amici?____________________________________ 'Amici affirms life, creativity and the power of compassion' Financial Times We will contact you to confirm membership on receipt of your application.
Administration by Turtle Key Arts T 020 8964 5060 F 020 8964 4080 admin@turtlekeyarts.org.uk Registered Charity No: Amici 1058780 Turtle Key Arts 1003113