Please tick here if a new member
Office use only

2019-20 Swindon U3A Annual Membership Application Form
Registered Charity No. 298853

To ensure that the information we hold is correct, please complete all sections and return to,
U3A Office, Gorse Hill Community Centre, Chapel Street, Swindon, SN2 8DA"

By joining Swindon U3A you give your consent for your personal details to be used as stated in the
Swindon U3A Privacy Policy, available on the Swindon U3A Website, www.swindonu3a.org.uk.

First Name:
Last Name:
Known As:
Mobile Number:
Email address:
Address:
Town:
Post Code:
Telephone Number - STD Code:
Number:
Gift Aid:
I confirm that I pay tax and that Swindon U3A may claim gift aid on my subscription
By Agreeing that Swindon U3A can claim Gift Aid, you agree to your name being passed to HMRC.
You may cancel this at any time and must cancel if you cease to be a tax payer by informing the Swindon U3A Office.
Associate Member:
Tick here if you are a member of another U3A that pays your capitation fee
If you are a member of another U3A that pays your capitation fee, your 2019-20 subscription is: £28.5
Newsletter:
Tick here to receive a printed version of the Newsletter
Third Age Matters:
Tick here to receive Third Age Matters at this address.
I agree to my name and address being passed to the Third Age Matters distributor.
The 2019-20 subscription is £32. I am paying by   CASH   /   CHEQUE   /   On-Line Bank Transfer - please indicate which
If paying for more than one member, enter the amount:  £
and their name
The Swindon U3A bank account details are:-   SORT CODE: 40-52-40     ACCOUNT NO:  00022105
Please use your last name follwed by the last six digits of your telephone number as the payment reference.
Your Payment Reference:
Your membership card will be held at the U3A office for collection unless you provide a stamped addressed envelope for it to be sent to you.