MEMBERSHIP - Mousetrap Theatre Company Inc.

Renewal or New Membership*

Renewal
New

*

Adult
Concession
Junior

Name*

Address*

Home Phone

Mobile*

Email*

Date of Birth if applying for Junior or Concession membership

Is there a disability we should know about

Emergency Contact Details and Parents/Guardians for Minors. Name and Phone Number*

Parent or Guardian Email address required for Junior members

Date*

Media Release*

Yes
No

Payment Details*

Trybooking
Bank Transfer
Cheque

Trybooking Ticket Number

Concession Card Details

Media Release for Junior Members and Members Agreement *

I/We, the Parent(s)/Guardian listed in the Minors/Junior Section, give permission to Mousetrap Theatre(hearinafter referred to the "MT")to take photographs, video recordings, etc.( hereinafter referred to as "Works") of my child and to use these Works in any and all media. I acknowledge that my child's name and identity may be revealed therein.

I/We do hereby release to MT and its agents all rights to exhibit these Works in printand electronic form publicly or privately and to market and sell copies. I/We understand that there will be no finacial or other remuneration for these Works.

I/We understand that these Works may appear in electronic form on the internet or in other publications outside of the MT's control. I/We agree that MT will not be resposnsible for any harm that may arise from such unauthorised reproduction. I/We release and indemnify MT from any loss, damage, cost, expense or claim arising out of the use of these Works, including but not limited to actions, defamation, libelous material, breach of privacy, or copyright.

All members must agree to abide by the Theatre's Bylaws in member behaviour and conduct.
I agree