HALESWORTH & DISTRICT u3a NEW MEMBER APPLICATION FORM This form can be used by a single person or two people living at the same postal address AND if you intend to pay via BACS or Standing Order ONLY. The membership is valid from 1st September until 31st August the following year. Please complete all relevant fields of the form. Fields shown with an asterisk are required fields which must be completed. Only persons seeking a NEW membership should use this form. Existing members wishing to renew their membership should use the Membership Renewal Form MEMBER DETAILS * MEMBER 1 DETAILS Full Name 1 * Full Address * Email Address 1 * Home telephone (if applicable) Mobile telephone 1 MEMBER 2 DETAILS Full Name 2 Email Address 2 Mobile telephone 2 MEMBERSHIP FEES * Please select the appropriate boxes below. The amounts below include a £3.50 fee per person to the Third Age Trust. ## Fee reduced by £3.50 per person if you are a current member of another u3a. If one new member is a member of another u3a and the other is not then separate applications for each new member are required. Member 1 - Other u3a Membership Details Member 2 - Other u3a Membership Details One member £15 annually * Two members at the same address £30 annually * ## One member £11.50 annually * ## Two members £23 annually * I/we will pay the annual membership fee using one of the two methods below: BACS transfer to Halesworth & District u3a * Bank Standing Order - I/we have sent instructions to our bank using the u3a Standing Order Form on the Membership Page * Account Details for BACS payments: Halesworth & District u3a, Sort code 30-13-64, Account number 00680986. Please put your name and u3a membership number in the reference box. GIFT AID * By signing up to Gift Aid, Halesworth u3a will receive additional funds from HM Revenue & Customs. You need to pay enough Income Tax or Capital Gains Tax in each year to cover the Gift Aid claimed on your member subscriptions and all your other charitable gifts for each tax year. If you do not pay enough tax to cover these gifts then you are responsible for paying any difference. I/we wish to Gift Aid past, current and future subscriptions: Yes to Gift Aid No to Gift Aid VOLUNTEERING * Yes I/we are willing to volunteer since the u3a is a mutual help organisation and operates through the contributions of volunteers. u3a MAGAZINE * Yes I/we would like to receive a TRIAL COPY of the Third Age Trust quarterly magazine (at no additional cost) and consent to my/our data being shared with the company that distributes the Trust magazines. * MEMBERSHIP DECLARATION In accordance with the principles of the Third Age Trust, I/we agree to: Abide by the principles of the u3a movement (Self Help Learning; Mutual Aid; for everyone not in full time work) Always act in the best interests of the u3as and never do anything to bring the u3a into disrepute Abide by the terms and conditions of the Constitution and policies published on the Governance page of our website Treat fellow members with courtesy and respect always Comply with and support the decisions of the elected Committee Advise the Committee of any changes in my/our personal details PRIVACY STATEMENT I/we understand that personal data supplied on this form will be used as described in detail in the u3a Privacy Policy in order to: Store it for membership purposes Communicate with me/us as a u3a member Share with Group Leaders for the Interest Groups of which I/we are a member I/we understand that our data will be stored on the u3a BEACON membership database to be used for the purposes described above By pressing the Submit button below I/we apply for membership of Halesworth & District u3a and agree to abide by the terms of the MEMBERSHIP DECLARATION and the PRIVACY STATEMENT above. Submit