MEMBERSHIP APPLICATION FORM

To
Mr Glynn Nixon
Copper Beeches
Knapp Lane
Painswick
Stroud, GL6 6YE

I/We* apply for membership of Stroud and District U3A and enclose £15.00/£28.00* subscription fee (Cheque or PO payable to Stroud and District U3A) and a stamped addressed C5 envelope (approx 9"x6") for membership material. I understand and agree that information provided will be used for U3A purposes only.

1st Applicant

2nd Applicant *

Surname

(Mr/Mrs/Miss/Ms*)

(Mr/Mrs/Miss/Ms*)

First Name

Email
Address(es)

Address

Postcode

Telephone

 

Signature:........................................................................... Date:.......................................

* Delete if not applicable

We would be grateful if you would also complete the Gift Aid form