Burnham on Crouch u3a

Membership Renewal Form

Renewing by form? If you received a renewal email with a personal link, please use that instead — it is quicker and your details will be shown for you to check. Use this form if you do not have your renewal email to hand.

Please complete all fields. The Membership Secretary will compare the details you submit with your current record and update anything that has changed.

Fields marked * are required.

Personal details

Title

First name *

Surname *

Address

Address line 1 *

Address line 2

Town

County

Postcode *

Contact details

Telephone (home)

Telephone (mobile)

Email address *

Confirm email address *

Renewal fee

£13.00 (annual membership — 1st June to 31st May) Your membership year runs from 1st June to 31st May.

Payment method

Bank transfer (BACS) — preferred
Burnham on Crouch University of the Third Age (u3a) | Sort code: 20-19-95 | Account: 40950181
Please use your surname and initial as the payment reference.

Cash at a meeting

Gift Aid

Gift Aid Declaration

I am a UK taxpayer. I understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations, it is my responsibility to pay any difference. I want to Gift Aid my membership subscription to Burnham on Crouch u3a. The membership renewal fee is £13.00 and Gift Aid will be claimed on this amount if I agree above. This fee secures membership of the u3a only and does not secure rights to personal use of any facilities or services provided by the u3a. This fee also includes a £4 fee that is paid to the Third Age Trust.

I am a UK taxpayer and I want to Gift Aid my membership subscription to Burnham on Crouch u3a.

Emergency contact

In case of emergency while you are involved in u3a activities, who should we contact?

Name *

Relationship

Best telephone number *

Medical information

Do you have any medical conditions or needs that we should know about in case of emergency while you are involved in u3a activities? This information is held in strict confidence and will only be used in case of emergency.

Terms and Conditions of Membership

I understand that all u3a activities are undertaken at my own risk, and I agree to:

Abide by the principles of the u3a movement
Always act in the best interests of the u3a and never do anything to bring the u3a into disrepute
Abide by the Burnham on Crouch u3a constitution
Treat fellow members with respect and courtesy at all times
Comply with and support the decisions of the elected committee
Advise the committee of any change in your personal details as recorded on this form

I confirm I have read and agree to the Terms and Conditions of Membership of Burnham on Crouch u3a. *

Privacy statement: Your personal details will be held securely and will be used solely for the purpose of administration and distribution of Burnham on Crouch u3a communications.