Membership Application Form - U3A Site Builder Home Page

Membership Application Form
Dengie & District U3A
Title: ……..
Forename: …………………………
SURNAME : ………………………………………………………..
Title: ……..
Forename: …………………………
SURNAME : ………………………………………………………..
ADDRESS: ………………………………………………………………………………………………………………………………………….
Postcode: ……………………………………
Telephone: …………………………………………………………………..
Email: ……………………………………………………………………………………………………………………………………………………
I wish to apply for membership for year ending March 2015.
Subscription: £15 per annum
PAYMENT: The annual subscription is payable on 1st April. If a member joins after August the membership
will be £10 for the year and if after December £5 for the remainder of the year. Please make cheques payable
to Dengie & District U3A
Are you a member of another U3A?
YES/NO If Yes which one? ……………………………………
Do you plan to attend the monthly meetings
YES/NO
Are you a Uk Taxpayer and prepared to Gift Aid
YES/NO If Yes please complete a form
Where did you hear about us
…………………………………………………………………………………………………………..
I/We understand and agree to the terms and conditions of membership contained in the Constitution and
Policy Document. These documents are held by the Secretary and you are encouraged to read them. Your
Data is held in a secure Database and will be used solely for administration and communication of U3A matters
and will not be supplied to any outside agency
Signature: ……………………………………………………………
Date: ………………………………………………………………
Signature: ……………………………………………………………
Date: ………………………………………………………………
Interest Groups:
Please circle any from the current group list that you would like to attend
Computing
Psychology
Dancing
Wildlife
Foodies
Local History
Games
Family History
Photography
Lunch Club
Guitar
Dengie Walks
Wine appreciation
Discussion
Please indicate any additional Groups/activities you might like our U3A to consider offering and whether you
would be willing to lead a group
Suggested Groups ………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
Group I could lead ………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………