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
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