(PLEASE PRINT)

 

Title______________ Name       ___________________________________

 

Address      ___________________________________________________

 

____________________________  Post Code      ____________________

 

Telephone______________    email    ______________________________

 

Hobbies/Interests     ____________________________________________

 

How did you hear about us?____________________________________

 

I agree to this information being stored manually or on a computer for U3A use only.  U3A will not pass this information to any other organisation without your permission.

 

SIGNED_______________________        DATE         _________________

 

I enclose payment of the sum of £12.00 p.a., for the year commencing January 1st 2010 or £8.00 from 1st July 2010. (Reduced fee of £9.50, or £5.50 respectively, if a copy of current membership card from another U3A is attached)

 

Text Box: CHEQUE

 

Text Box: CASH

 

£____________

 

 

Cheques should be made payable to:  Weymouth & Portland U3A

and sent to:

Pat Woodley, 36 Brunel Drive, Preston DT3 6NX

 

GIFT AID DECLARATION – Charities can reclaim tax on subscriptions/donations under the Gift Aid Scheme.  You must be a UK taxpayer and have paid in the last tax year income or capital gains tax at least equal to the tax we reclaim.  Your declaration can be cancelled at any time if your circumstances change.

 

I am a UK taxpayer, and wish the tax to be reclaimed on this and all future subscriptions/donations I make to Weymouth & Portland U3A.

 

SIGNED___________________________  DATE:__________________

 

RENEWAL    or     NEW MEMBERSHIP     (Circle as appropriate)

 

Weymouth & Portland U3A is a Registered Charity No 1109191