(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.
I enclose payment of the sum of £12.00 p.a., for the year commencing January 1st 2006, or £6.00 from July. (Fee of £9.50, or £3.50 from July, if a copy of current membership card from another U3A is attached)
Cheques should be made payable to: Weymouth & Portland U3A
and sent to:
R. Gill, 4 Brookside Close, Preston, Weymouth, Dorset DT3 6DW
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:__________________
Weymouth & Portland U3A is a Registered Charity No 1109191
RENEWAL OR NEW MEMBERSHIP
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