Memberships — The Regent

STAR MEMBERSHIP

SILVER

UNLIMITED MOVIES FOR ONE PERSON FOR ONE YEAR!
GOLD

UNLIMITED MOVIES FOR TWO PEOPLE FOR ONE YEAR!
MUST LIVE IN THE SAME HOUSEHOLD
PLATINUM

UNLIMITED MOVIES FOR FAMILY OF FOUR FOR ONE YEAR!
ADDITIONAL MEMBERS AFTER FOUR ARE $25 EACH

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Checkbox

Silver ($125)

Gold ($200)

Platinum ($300)

Additional Platinum after 4 ($25 each)

Name(s) on Card(s)

Memberships may be picked up at the Regent Theatre during normal business hours. Memberships will be paid for upon pickup.

SILVER