Assoc_Application

Application for Associate Membership

The membership year runs from 1st September to 31st August and the subscription is £10 per
year. One form is required for each application.
IMPORTANT: This form is for ASSOCIATE Membership only. You must be a FULL member of another u3a.
Please complete this form, including your preferred payment details and u3a affiliation.

Title

Mr/Mrs/Miss/Ms/Other

Name

Address

Home or Mailing Address

Post Code

Please provide at least one phone number

Phone Number (0xxxx xxxxxx)

Mobile Number (0xxxx xxxxxx)

Email address

I am a current member of

Your full membership u3a

u3a

Payment can be made by: (please select one)

Standing Order Bank Transfer

We would prefer you to agree to pay by Standing Order: if you do would you please complete the separate “Standing Order Payment” request form. Click the link below to download and print the form. Then return it to YOUR OWN BANK.

When paying by Bank Transfer please include your name and initials as a reference.
Bank Details:
Account Name: Petersfield U3A
Sort Code: 40-52-40
Account Number:00010830

Standing Order Form

Note that either method can also be done on-line.

Gift Aid: If you are a UK taxpayer and would be willing for the u3a to claim Gift Aid on your behalf, please confirm

Yes No

The information, both above and below, is kept by Petersfield u3a for membership purposes and to
communicate with you as a member and by leaders of those groups of which you are a
member and to other members of such groups. Your address is also added to the direct
mailing list for the Third Age Trust (the national organisation to which u3a’s are affiliated) and
to the distribution list for News & Views and Connect. You can request that your data may not
be used as above at any time, by contacting the Membership Secretary. Full details of our
Data Protection and Privacy Policy may be found on the Petersfield u3a website,

Petersfield u3a

All communications, including the weekly Connect, and the News & Views magazine are sent out electronically.

Please re-enter your name below to indicate your consent to the above:

Name

Date

Select date

Petersfield u3a is run by volunteer members for the benefit of the members and depends for
its continuing success on the active participation of all members. Please complete this
questionnaire below to give details of what experience and interests you have which might be
of value to other members and give an indication what you can contribute to help with leading
a group or involvement with the committee and administrative support. This information will
help us to plan for the future and keep our u3a current and relevant to all our members.

What is your reason for joining the Petersfield u3a?

What sort of activities are you interested in?

Do you have any previous experience of these? Please elaborate

Can you help with an existing group or start another?

Whar sort of assistance can you contribute to the running of the u3a?

Would you be willing to join the Management Committee in the future?

Would you mind giving a rough indication of your age?

55-64 years 65-74 years 75 years or older

Comments

After submission a confirming email will be sent to the address above.