The UNIVERSITY of the THIRD AGE
Registered Charity No. 1038532
TITLE………FORENAME
…………………………SURNAME……………………………INITIALS…………
TITLE………FORENAME
…………………………SURNAME……………………………INITIALS…………
(for two members at the same address)
ADDRESS…………………………………………………………………………………………………………..
…………………………………………………………………………………………POSTCODE……………...
[TELEPHONE]………………………….[EMAIL]………………………………………………………………..
The two items in the square brackets are optional and should only be provided if you are willing for them to be entered on the Warwick District U3A data-base.
Do you have a mobility or any other physical problems? Please state, if you so wish........................................................
Annual Membership Fee: Sept 1st to August 31st - £14.00 per person, (£7 after 1st March)
I enclose my/our remittance of £……………….., in respect of my/our membership until 31st August next.[Note: if you are applying for membership between 1st July - 31st August, please contact the Membership Secretary.]
SIGNATURE(S)……………………………………………………………………..... DATE……………………...
Cheques to be made payable to: WARWICK DISTRICT U3A.
Please return the
completed form, along with your remittance to either:-
Warwick District U3A - Mrs P Puddifoot, 17 Barrow Road, KENILWORTH, CV8
1EG. Tel - 01926-779120,
or:- handed in to the Information Desk at a Wednesday open
meeting.
Data Protection Act 1998. Details obtained from this form will be held on computer and in accordance with the above Act, and will be used by U3A only for administration purposes.
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For
Administration Purposes only
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| Payment rec'd | £ Cash/Cheque |
| Membership No | : |
| Date Card Issued | : |
| INFO Given | Info No. |
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