CESTRIAN U3A
APPLICATION for MEMBERSHIP
Name(s)
Address
Postcode
Subscription: £15 per person per annum payable by cheque only please
(Please make cheques payable to ‘Cestrian U3A’)
Please find enclosed a cheque for £ in payment for my/our 2009 subscription/s
(Signed)
Telephone
E-
Please return this form with your cheque
together with a stamped, self addressed envelope for your membership card to:
The Membership Secretary, Mr R Howard, 76 Crossfields, Tarvin, Chester CH3 8EP
We maintain a database of members’ details used exclusively for Cestrian U3A administration.
This information is never passed to third parties, but if you do not wish your information to be recorded on the database, please indicate your preference by placing a cross in this box:
If you pay income tax, why not increase the value of your subscription at no further cost to yourself
by signing a Gift Aid declaration? To be sent a form with your membership card, please tick box:
