Graduation Video and DVD order from

Please complete all sections A to C by typing in the boxes, then print out and send this form with your payment to:

Black Swan Film and Video, 11 Finch Road, Reading RG6 7JX

Date of your ceremony: Time of your ceremony:

Name of the graduate:

B) Your order:

UK ORDERS ONLY

I would like to order 0 1 2 3 4 5 6 DVD/s (SOAS, Kingston & Bath £30 each FREE postage to UK addresses)

I would like to order 0 1 2 3 4 5 6 DVD/s (South Bank £25 each FREE postage to UK addresses)

I would like to order SOAS/Kingston/Bath 0 1 2 3 4 5 6 DVD/s posted within Europe (£33 each) DVD/s posted outside EU (£36 each)

I would like to order South Bank 0 1 2 3 4 5 6 DVD/s posted within Europe (£28 each) DVD/s posted outside EU (£31 each)

I enclose a total of £ (Cheques / postal orders made payable to Black Swan Film and Video)

Please send my order to:

(Fill in your Name and Address in the box below)