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 ……………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………………………………