Membership Form

IMPORTANT – Please make sure there is space for you in your chosen activity by contacting the Group Leader on the relevant group page on this website.

Membership Status *New MemberCurrent Member

Membership Number

Title *

First Name *

Surname *

How would you like to be addressed? *

Email Address *

Phone Number *

Adress 1 *

Adress 2 *

Post Code *

Emergancy Contact (Name and Telephone No.)

Activities? *

Membership Fee and Weekly Group FeeNote: Group Leaders do not tick for your own group as you will be chargedFull Years MembershipBadminton (£10 per Membership year)Monday Art (£10 per Membership year)Guitars+ (£10 per Membership year)Pickleball (£10 per Membership year)Table Tennis (£10 per Membership year)Ukulele Main Group (£10 per Membership year)

u3a Magazine at £4 extraYesNo

Tick If You Are A Group Leader (Attending other groups)Going to other groups

Tick If You Are A Group Leader (NOT attending other groups)Not attending other groups

FeePlease pay the fee shown as soon as possible after completing the form

Payment of fee options *Please select how you would like to pay your fees. How to pay details are below the form.Bank Transfer (preferred)ChequeOther (please give details in the box below)

Other details0 / 180

Please select one option (only for new members)

Choose one option *Verwood u3a can claim gift aid from the government at no cost to youI am a U.K. taxpayer and agree Verwood u3a can claim Gift AidI am not a U.K. taxpayer or do not agree Verwood u3a can claim Gift Aid

Date *

Day

Month

Year

Bank Transfer:
Please write Membership and your Surname as reference and pay:
Verwood u3a.
Sort Code: 20-72-37.
Account Number: 80233196.

Cheque:
Payable to Verwood u3a with your Name, Postcode and write ‘Membership’ on the back and then send to…
Verwood u3a Treasurer
22 Oaklands Close
BH316NZ.

Membership Form

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