Membership Application Form - Caterham and District

Title

Name

First

Last

Known As

This is how you are most commonly addressed if not your name above.

Address

Address Line 1

City

State / Province / Region

Postal Code

Email

Confirm Email

Most of our communication will be by email as this keeps the cost of membership low.

Telephone (home/landline)

Mobile Phone

Emergency Contact and Phone Number

This is optional but useful for us to have please.

Type of Membership (click for choices)

Third Age Magazine (TAM)

I wish to receive the u3a Magazine Third Age Matters (TAM) and consent to my data being shared with the distributors

Please note that you will only receive three editions of the TAM magazine after which you will automatically be opted out unless you advise otherwise

If joining as an Associate Member, which u3a do you already belong to?

How would you like to pay?

By Bank Transfer (BACS) - preferred. Please note our bank details which appear below once you select this option.
By Bank Card (we prefer you not to use this, only if you have to for some reason)

Choose just one method. Please note we no longer accept payment by cheque.

Membership Fees can be paid by BACS bank transfer using the following details:

Account Name: Caterham & District u3a
Sort Code: 60 04 35
Account No: 11067721

Please use your name as the payment reference.

I agree to Gift Aid my membership

Yes
No

If you are a UK taxpayer, we can claim 25p from the Government for every £1 of your membership payment donation. It costs you nothing; all you have to do is tick the box above and we will do the rest. If you agree, we will treat all membership payments made to Caterham and District u3a as Gift Aid donations until you notify us otherwise. Caterham and District u3a is a registered charity, no. 1172231.

Statement to? Conduct

I agree to follow the Code of Conduct of the Caterham and District u3A

Yes

By agreeing you are accepting that you will follow the Aims and Guiding Principles and Code of Conduct of the Caterham and District u3a which can be found on the Procedures page of this website.

Privacy Statement

I consent to my data being used for membership purposes as detailed below

Please tick the appropriate box above to give us permission to use the information you have supplied in the following ways: 1. To store it securely for membership purposes. 2. To communicate with you as a u3a member. 3. To share with Group Leaders for those groups that you have joined. 4. To send you general information about the Third Age Trust (the national organisation to which u3a’s are affiliated).

Date