Learn, laugh, live

Application Form

Application to Join Milford & District U3A – 2021/22

The annual subscriptions are £18 for current members and £24 for new or returning members. The only level of membership will be Full. Please complete the application form below. For the first person please enter the full name of the person paying as on the payment (cheque or bank details)

Should you have any queries regarding completing this form please contact our Membership Secretary, Lavinia Martins on 07743 129886.

Application / Renewal form 2020/2021

Full Name *

Are you an existing (2020/21) Member? *

Yes

Membership Number (if known)

For existing members only

Address *

Town *

Postcode *

Home Phone Number

Mobile number

The second person at the same address, if applicable.

Full Name of Second Person (at same address)

Membership Number (if known)

For existing members only

Mobile number

Communication Preferences

Please tick the boxes below that you want

to receive Monthly News, alerts and meeting reminders (only sent by email)

a printed copy of the Programme, alternatively available from our website

to receive the Free Third Age Matters magazine and consent to your details to be shared with the company that distributes it.

Payment Options

The membership fee is £18 per 2020/21 member , £24 for new or rejoining (pre 20/21) members.

Please select: *

I have paid by direct debit to GoCardless using the link below *(takes less than 1 minute to set up) *

/we have made an electronic transfer to Milford and District U3A, Lloyds Bank plc, Godalming Branch, sort code 30-93-49 account number 00790682, using my surname and postcode as reference

I/we have posted a cheque, made out to Milford and District U3A, to the membership secretary: U3A (Milford) Membership, PO Box 850, Godalming, GU7 9JQ

*Set up Direct Debit using GoCardless https://pay.gocardless.com/AL0002E5ZG1YMD

Gift Aid - Are you a UK taxpayer?

Are you a UK taxpayer? We receive an additional 25% if you complete the next section

We are Milford and District U3A - Registered Charity Number 1096120

Gift Aid Option *

I wish to Gift Aid my donation and any future donations to Milford and District U3A

I do NOT want to Gift Aid my donation

Name of person making the donation (if Gift Aid selected)

I am a UK taxpayer 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 any difference.

Please notify the Milford and District U3A if you want to cancel this declaration, change your name or home address, or no longer pay sufficient tax on your income and/or capital gains.

Ts and Cs

I/we agree to the terms and conditions, and acknowledge the legitimate interest that Milford & District has in retaining information as outlined in the privacy statement as stated on our website.

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