Membership Renewal Form 2011/12

I enclose a cheque for £15.00 / £28.00 (please delete as appropriate) for my/our annual membership of the Stroud & District U3A. I also enclose a SAE for the return of my membership card.

Name(s).......................................................................................................

Address........................................................................................................

...................................................................................................................

....................................................................... Post Code ............................

Email ............................................................... Tel. No................................

This information will be stored on our computer database and used only for U3A purposes

Gift Aid Declaration

Please tick whichever statement is appropriate for you:

[ ] I have already completed a Gift Aid Declaration and wish it to continue.

[ ] I have already completed a Gift Aid Declaration and wish to terminate the arrangement.

[ ] I shall not be taking part in the Stroud U3A Gift Aid Scheme.

[ ] I wish to take part in the Stroud U3A Gift Aid Scheme and complete the following declaration:

To: University of the Third Age Stroud & District Branch
Registered Charity No. 1030673

I …………………………………...............…………………………… confirm that I am a UK taxpayer, resident in the UK for tax purposes and pay at least as much tax as my U3A subscription. I authorise the U3A to treat as Gift Aid donations all subscriptions I make from the date of this declaration until I notify you otherwise.
** [In addition, please include all donations I have made since April 2006.]

Signature……………………………………….............……………... Date………….......………………..

** please strike out this sentence if it is not appropriate.