Membership Form

Huddersfield & District University of the Third Age
2 Oldgate, Huddersfield, HD1 6QW 01484 225208

Title: forename: surname:

Address

Town

Post Code Telephone No

I wish to apply for membership of the Huddersfield & District University of the Third Age. I am over 50 years of age and/or registered as a disabled person (Please delete as appropriate).

I understand that payment of the Annual Membership Fee of £6.00 will enable me to participate in the activities of Huddersfield & District U3A for the twelve months beginning 1 April, including attendance at classes which will normally be held from September to March as detailed in the Annual Prospectus. This will be published in early June and sent to me by post. A fee per term is payable for each class attended as detailed in the Prospectus.

I also understand that the information I give on this form will be recorded in the Huddersfield and District U3A computer which is based in the Oldgate House Office and that this information will be used to produce Class Registers and to assist in the planning of U3A activities.

No information that could identify individual members will be disclosed to any unauthorised person.

Signed _{__________________________________________}_{Date
____________}_{If you are making this application by post
please send it to the address shown below enclosing a cheque or
postal order made payable to 'Huddersfield & District U3A' As
a matter of security, payment by cheque is preferred, but if necessary
you can pay by cash at the Central Library Office
which is open on Saturday morning 10.00am to 12 noon and Monday1.00pm to
3.00pm.}

For Office use only £6.00 Membership Fee received by date

Prospectus issued

Membership No

If you would like to support the U3A as a tutor or office worker, or assist at functions or in any other way, please let us know.