ONLINE APPLICATION FORM - Wadhurst & District

SURNAME

FIRST NAME

Please enter your first name/name you are commonly known by

TITLE

Single Line Text

YEAR OF BIRTH (format:19nn)

Used for statistical purposes only. It's valuable for us to understand the demographic profile of our membership.

ADDRESS LINE 1

First Line of Address

TOWN/VILLAGE

Please enter your nearest town/village

POSTCODE

Post code

our POSTCODE

YOUR EMAIL ADDRESS (Please note: Email is our principal means of communicating with our members.)

Email

Confirm Email

HOME TELEPHONE NUMBER

MOBILE NUMBER

HOW DID YOU HEAR ABOUT WADHURST & DISTRICT u3a?

Single Line Text

ARE YOU CURRENTLY A MEMBER OF ANOTHER u3a?

YES
NO

IF YES, which one(s)?

PLEASE NOTE: If you are a current member of another u3a, you are entitled to a reduced annual subscription fee of £21.50 at Wadhurst & District u3a.

WOULD YOU LIKE TO SIGN UP TO GIFT AID?

YES
NO
Perhaps, I'd like more information

Please ensure you have read and understood all the information relating to Gift Aid set out on our "How to Join" page.

DO YOU HAVE ANY SPECIAL NEEDS? (eg mobility, sight, hearing impairments)

YES
NO
Prefer not to say

This is an important to ensure we are able to fulfil our obligations set out in our Equality, Diversity and Inclusion Policy.

If YES, please specify so we know how we may be able to assist you.

EMERGENCY CONTACT DETAILS: Name/Relationship

Please let us have the name of someone we should contact in an emergency and their relationship to you

EMERGENCY CONTACT TEL NUMBER

HOW WOULD YOU LIKE TO PAY YOUR £25 ANNUAL MEMBERSHIP SUBSCRIPTION?

Bank Transfer
Credit/Debit Card

Please note that due to bank charges, we are no longer able to accept cheques or cash. For Bank Transfer, please make payment to: Sort Code: 30-98-77 Acct Number 48499968 Account Name: Wadhurst U3A. If you are a current member of another u3a the annual fee is reduced to £21.50. If you would like to pay by card, you will need to pay in person at one of our monthly meetings.

GDPR Agreement

I consent to the information I have submitted via this website being stored and used for the purposes of ongoing communication and analysis.

CONFIRMATION

YES, I confirm

I wish to apply for membership of Wadhurst & District u3a and agree to abide by the Aims, Guiding Principles and Policies set out on this website. I confirm that I have read the supplementary information of GDPR Regulations 2018 and consent to my information being used by this u3a in the ways described.