THE CHINNOR & DISTRICT U3A (UNIVERSITY OF THE THIRD AGE)

Registered Charity No. 1078824

APPLICATION FOR MEMBERSHIP

1. Name (Title, Preferred Forename(s )& Surname)

2. Address including Postcode.

3. Telephone Number:

4. E-mail Address:

5. Are you Retired/Semi retired? If Semi Retired when do you anticipate full retirement?

6. What was your occupation before retirement/Semi Retirement?

7. Are you a member of any other U3A?

8. Are any members of your family currently members of Chinnor & District U3A?

9. Would you be prepared, at some time, to serve on the U3A Committee or act as

an Interest Group Leader?

10. Special Interests/Preferences to join any Interest Groups.

11. Preferred Subjects for Monthly Talks.

Date ............................ Signature ..............................................................

When this form has been completed, please scan it and add as an attachment on an e-mail to: membership@chinnoru3a.org.uk. You will then be advised as to whether there are any vacancies or whether there is currently a Waiting List.The Annual Membership fee is £12.00 per member and is payable once an Application has been accepted by the Management Committee. The Membership Year commences on 1st June each year.

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For Office Use.	08/2006
Receipt acknowledged (date):	Invitation letter sent:
To Admin.Secretary:	Membership Fee recd.:
To: Membership Secretary :
To Interest Groups Secretary :