Membership Form

Please complete the form below using BLOCK CAPITALS.

Title: Mr/Mrs/Miss/Ms/Other______________________________________________

Name: ____________________________________________________________________

Email: ____________________________________________________________________

Telephone: ________________________________________________________________

Address: __________________________________________________________________

__________________________________________________________________________

__________________________________________________Postcode: _______________

You are very welcome to contact individual Convenors for details of group activities, locations and timings, and you may wish to attend a meeting before deciding if you want to join.

Please enclose a cheque for £20 subscription (£10 if you join after July) for the current year (January to December) made payable to ‘Salford U3A’. These subscriptions include the fees to the Third Age Trust for central services and to Third Age Matters for its production and postage. All memberships must be renewed from 1 January each year.

Gift Aid Declaration

If you are a UK tax payer we, Salford U3A, can reclaim 25% of your subscription in Gift Aid. This helps offset our various expenses.

If you wish to Gift Aid your subscription, please tick the Gift Aid box below:

□ I am a UK taxpayer and would like to Gift Aid this and future subscriptions to Salford U3A.

Signature: ________________________________________ Date: ____________

The data provided will be held and maintained on our database only for the purposes of correspondence and contact as authorised by the Committee, through the Membership Secretary, on a strict ‘need to know’ basis – e.g. to Convenors in the event of illness. When you leave the U3A, it will be deleted. The Third Age Trust also needs your address for its own database so that it can provide you with copies of Third Age Matters direct to your home. This is in line with the advice provided by the Third Age Trust and complies with the Data Protection Act.

Please send:

1. This completed form

2. Your cheque, made out to ‘Salford U3A’ to:

Please send the above information to: Membership Secretary – Ann Teale, 17 Waterdale Close, Worsley, Manchester M28 1YP

We would also be interested to know how you heard about us, i.e. U3A flyer/our web site/friend/Head Office – please indicate………………………………………..

Registered Charity Number 700706