Application Form - Milton Keynes U3A

APPLICATION FOR MEMBERSHIP
Please complete form in BLOCK CAPITALS
(W)
(1) Mr Mrs Miss Ms Other........... (Circle or indicate as appropriate)
Forename(s)
Surname
(2) Mr Mrs Miss Ms Other........... (Circle or indicate as appropriate)
Forename(s)
Surname
Mem. No.
Mem. No.
Address
Town
Postcode
Telephone
Mobile
Email (1)
Email (2)
If applicable, please enter name and Membership No of
spouse/partner
How did you hear about the MKU3A?
Which group/s are you planning to join?
What new groups, not currently available within MKU3A,
would you be interested in joining?
The MKU3A Office is staffed by members with previous experience in administration, and use of
Yes
No
Windows Office facilities. Would you be interested in becoming involved if vacancies arise?
Our Open Meetings and various other social events are dependent on volunteer assistance in
Yes
No
various fields. Would you be able to help?
Please enrol me/us as member/s of MKU3A
MDB 
Card 
CAF 
MC 
Signed:
Date:
Membership fee is £15 per person per annum. Please tick relevant box for the payment method used
 Direct debit (preferred): Complete a Direct Debit Mandate and return it to MKU3A with the completed application
form.
 Electronic transfer: Pay MKU3A using the following bank details and return the completed application form to us.
Account name: MKU3A
Account No: 00004826
Sort Code: 40-52-40
Ref: Mem application (Surname)
 Cheque/Postal Order: Please send a cheque/Postal Order payable to MKU3A with the application form to the
Membership Secretary at the MKU3A office.
Data Protection Act
We are compliant with the aims of the act. Your information will be held and maintained on a computer for the
purposes of correspondence/contact only.
Gift Aid Declaration
Using Gift Aid means that for every £1 of your subscription, MKU3A receives 25p from HM Revenue and Customs,
helping our funds go further. Please treat my/our current and future personal subscription/s as Gift Aid. I confirm
that I am a UK taxpayer and that I pay at least as much tax on my income or capital gains as MKU3A will reclaim. I will
advise MKU3A if I wish to cancel this declaration in the future or I no longer pay sufficient tax on my income or capital
gains.
Signed (1)
Date
Signed (2)
Date
11 Winchester Circle, Milton Keynes, MK10 0BA
Tel: 01908 281717 email:[email protected] web: www.mku3a.org
Registered Charity No. 298693