I would like to become a member of Whitwick & District U3A.

I am applying via the Open Day offer:
Joining between 14th September - 31st October 2024 - £6

*If your are current member of another U3A you can reduce the above fees by £3.50

I am a member of U3A. If not applicable leave blank.

*Membership is free for those over 90 years old at the time of joining.

I am over 90 years old and wish to claim free membership Tick or leave blank

I undertake to make a payment of £ 6 . Details of how to pay will be provided by the Membership Secretary on receipt of this application.

I understand that the membership fee contains £4.00 which is sent to the Third Age Trust and also that I may be liable to pay other fees, as a member of individual Activity and Interest Groups.

General Data Protection Regulations (GDPR)

I agree to my personal data being held on computer for legitimate purposes of the Third Age Trust and Whitwick & District U3A business only. I accept that by providing this information I am giving my consent to being contacted by phone, email and post.

Surname

First Name

Title

First name to appear on badge*

* Your first name and surname will appear on your badge, if you have another preferred first name please state, otherwise leave blank.

Mobile Phone If not applicable leave blank.

Home Phone If not applicable leave blank.

Email Address If not applicable leave blank.

Full Postal Address

Post Code

Please supply a name and contact numbers of a person we can contact in the event of an accident or medical emergency, you must have their permission to do this! In providing this information you are confirming they have given their consent for you to give us their contact details. N.B. In the case of couples where both are members of Whitwick & District U3A, we strongly recommend that a separate third person is nominated as the emergency contact.

Contact Name

1st Phone Number*

2nd Phone Number*

* Please provide at least one contact number.

Signed By ticking this box you are confirming the above information to be correct and it is the equivalent of your signature on this application.

Date 02-11-2026

In addition to becoming a member, Gift Aid legislation allows us to claim 25p of tax for every £1 of your subscription. If you are in agreement with us doing this please sign and date this declaration.

I wish the Whitwick & District U3A to benefit from Gift Aid legislation and confirm I am a UK tax payer and I 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 the current tax year it is my responsibility to pay any difference.

Signed By ticking this box you are confirming the above information to be correct and it is the equivalent of your signature for Gift Aid.

Date 02-11-2026

Please check all the above before clicking the Submit button. You will be sent an email confirming your submission, and will be contacted by the Membership Secretary in the next few days.