MEMBERSHIP APPLICATION FOR WANDSWORTH U3A

Please use capitals,  joint members please show both names.

TITLE………….FIRST NAME….………………….…SURNAME…………………………

ADDRESS………………………………………………………………………………………

POST CODE….………………………Tel no………........................

E-Mail.................................................................................................. Date……………..

Subscription rates. Membership starts 1 March.

	1 Mar - 28 Feb	1 Jun- 28 Feb	1 Sept - 28 Feb
Single	£10	£8	£5
Couple	£16	£12	£8

Do you belong to another U3A ?   NO / YES  Please advise name.................................

If yes, note the subscription includes a levy of £3.50 per member to The Third Age Trust.

This should be paid only once by U3A members per subscription per year.

If you are paying this levy to another U3A, please deduct £3.50 from the above fee when

paying your subscription. Alternatively you can choose to pay it to Wandsworth U3A.

Enclosed £……...................... Cheque/Cash. Cheques payable to “Wandsworth U3A”

Please hand form to membership Secretary at a monthly meeting or post to:-

Wandsworth U3A, c/o Flat 37 Braemar, 12 Kersfield Rd. SW15 3HG.

Please enclose S.A.E. for return of membership card which acts as a receipt.

Subjects of interest: ...............................................................................

Previous / current occupation (optional)...............................................

Would consider forming a study group on .............................................

Please complete Gift Aid Declaration if applicable (see main menu).