Membership Renewal Form - North London U3A

First name *

Surname *

M'ship numberAs printed on your invitation to renew

Emergency contact (name and phone number)

Paying for one current member or a couple *One memberTwo members£36 per member

Partner's first name *

Partner's surname *

M'ship numberAs printed on their invitation to renew

Emergency contact (name and phone number)

Are you a full member of another u3a? *YesNoFor full members of another u3a, discount £8.00 for full year

Name of other u3a *to which you have paid full membership

Other u3a m'ship number *

Is your partner a full member of another u3a? *YesNoFor full members of another u3a, discount £8.00 for full year

Name of partner's other u3a *to which they have paid full membership

Partner's other u3a m'ship number *

We are issuing membership cards by email. Would you prefer a printed card? *YesNo

NLU3A exists because of members who volunteer to run interest groups and help with various other essential tasks. Would you consider helping in some way, either now or later? *YesNo

Receive print (rather than digital) copies of NLU3A’s magazine? *YesNoGet a print copy of “The Northern Line” magazine every term for £6 per year.

Current NLU3A Interest Group membershipList those you are a member of, separated by commas.

Skills and interestsPlease describe.

Additional donation (optional) *

GBP

If you wish to make an additional donation please enter the amount above

Total amount due

£

Payment method *By card online (preferred)Bank transferCheque

Payment by card *

Enter your card details in the boxes that appear here. The card details will be used for this transaction only and not saved.

Email Address *for card payment receipt

Bank transfer to:

Account name: North London University of the Third Age
Sort Code: 60-06-26 Acc.No: 87691469

When prompted please put your FULL NAME as a reference. If this is not done your payment will not be recorded!
NOTE: Your bank will check that you are really paying the business account: North London University of the Third Age. We have found that “North London U3A” will be accepted, but what is accepted by your bank may be different.

Cheque payable to:

North London U3A and sent to Membership Secretary at Flat 7 Collingridge House 5 Old Park Road Enfield Chase EN2 7BE.

Any changes?PLEASE NOTE The Membership Secretary will assume your email(s), postal address and Gift Aid status all remain unchanged. However if there have been changes in your contact details or your tax status since last year please let us know in this box.