Counter Image Membership Form/Course Application Form


Full Membership £27
Concession Membership £15
(Unemployed, students & Senior Citizens)
Voluntary Sector Company £30
3 Named Individuals
  1. Name............:
  2. Organization..:
  3. Address1......:
  4. Address2......:
  5. Address3......:
  6. Email Add.....:
  7. Tel No..........:

  8. For what are you applying?(check all that apply):
    New Member Renewing Member

  9. Your income is:
    Waged Unwaged

  10. For which course are you applying?
    Film Directing
    16mm Camera Operation
    Sound Recording for Film
    16mm Post Production
    Super 8 Film Production

  11. What are your areas of interest?
    film
    photography
    video
    photo imaging
    other
    Thankyou for taking the time to fill in this form

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