Application for a licence to perform a pantomime

NODA, 58-60 Lincoln Road
Peterborough, PE1 2RZ

Telephone 01733 865790
Fax 01733 319506

Patron:
The Lord Lloyd-Webber

Website: John Good

For non NODA members applying for a performance licence a surcharge of 20% will be added to the royalty figure.
Please note this surcharge is not added to the cost of scripts or video licence.

Please read the Important Notice and Conditions before completing this form. A Licence must be obtained for every public or private performance and for recording before rehearsals start.

We hereby apply for permission to perform

Pantomime

Author

Name of group

Venue for performances

Venue address

Venue postcode		Venue telephone
Maximum seating capacity of venue per performance (may be checked)		Total number of performances
Dates & times of evening performances		Dates & times of matinee performances

We hereby apply for permission to video/electronically record

Date of videorecording

Venue for recording

Any recording cannot be sold commercially under any circumstances!

Address for all correspondence

Applicant's name

Society name

Your position in society

Is your Society a NODA Member? Yes No

Address

Post code

Telephone (home)

Telephone (work)

Email address

Payment method

Online payment through NODA's secure store

Please make a note of your Application Reference Number (ARN).

Your ARN is 28681121

Terms & Conditions
Gift Aid Information