Romsey & District u3a MEMBERSHIP APPLICATION/RENEWAL
1 APRIL 2022 - 31 MARCH 2023
Please return to: Mrs M Fowler, 33 Winchester Road, Romsey SO51 8AB or email: marionfowler@btinternet.com YOUR DETAILS Title
Are you a current member? Yes / No
First Name
Surname
Member No. if renewing
Address
Post Code
Home Telephone
Email * EMERGENCY CONTACT
Mobile Name
Mobile /
Telephone
GIFT AID Please sign up if you can - boost your donation by 25p in every £1 and help us to cover our costs. I would like Romsey & District u3a to reclaim Gift Aid on my Membership contributions for this year and any I make in the future. I confirm that I am a UK tax payer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year, it is my responsibility to pay the difference. Please tick ONE box: I would like to participate
I am not eligible or do not wish to participate
* To reduce costs, the committee will communicate with you via email where possible.
MEMBERSHIP FEE Romsey & District u3a
One member £15.00
OR
Other u3a
One member £11.00 ** See below
My Membership fee will be paid by (please tick ONE): □ Standing Order - if already in place □ Bank Transfer to: Barclays Bank; University of the Third Age Romsey & District U3A; Sort Code 2 0-97-01; □ Account No. 20473111; Reference - your 4-digit Member No. OR your Surname, then initials □ Cheque made payable to ‘Romsey & District U3A’ ** If you are already a member of another u3a and pay your Third Age Trust Capitation Fee through them,
your Romsey & District u3a fee will be £11.00. Please complete the following declaration and sign it. I have paid or will be paying my Third Age Trust Capitation Fee to: Branch ……………………………………………. Member No. ………………… Signature ………………………………………………………..
*** PLEASE TURN OVER ***
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