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 (you can sign up for more than one charity):

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

Signature: ________________________________________ Date: ____________

Data Protection– Please tick the box below to give us permission to use the information you have supplied in the following ways:  to store it securely for membership purposes, to communicate with you as a U3A member, to share with group leaders for those groups that you are a member of, send you general information about the Third Age Trust (the national organisation to which U3As are affiliated) and happy to be added to the direct mailing list for the Third Age Trust magazines, Third Age Matters and Sources.  Should you leave Salford U3A your details will be deleted.

□  I consent to my data being used for membership purposes as detailed above.

Signature: ________________________________________ Date: ____________

Please send:

1. This completed form signed and dated.

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

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Registered Charity Number 700706