New Member Form

2021-2022 Harrow u3a New Member Application

Please read the New Member Information sheet before you fill in this form

* Indicates required field

Title *

Name *

First

Last

Full Postal Adress including Post Code *

Email *

Landline Phone Number *

Payment - BACS Details Name of account: Harrow u3a Sort code: 40-36-21 Account number: 01518518 *

Individual £20 Joint, first person at address, £30 Joint, second person at adress, £0 Person in receipt of Pension Credit, £12; please give DWP number in the next section

Mobile Phone Nnumber *

If someone else has made the BACS payment for you, please tell us their name, so we can recognise it on the bank statement. Ask them to use your phone number and 5 letters of surname as reference. If we may claim Gift Aid, please also confirm that you have reimbursed this person. *

Only if paying at £12 rate, DWP number please *

Gift Aid - if you are able, please allow us to claim Gift Aid by ticking the box. *

I want to Gift Aid my payment today, which counts as a donation to Harrow University of the Third Age, registered charity number 1009872, as well as any donations I make in the future or have made in the last year. I am a UK taxpayer, 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 a tax year, it is my responsibility to pay any difference. I understand that my name and address will be included in the annual claim that Harrow u3a makes to HMRC. I will inform the Membership Team of any change of name or address, or if I wish to cancel this declaration.

Terms & conditions of membership - please confirm. *

I apply for membership of Harrow u3a and confirm that I will abide by the terms of membership as stated in the New Member Information sheet and have read the Privacy Statement.

Date DD/MM/YYYY *

Year of birth (optional - it helps our planning if we know the age profile of the membership) *

All members of Harrow u3a receive a termly printed newsletter with details of all our activities. We also have an optional email news group to inform you between editions when there are new groups (& outings when these are again possible), late changes, etc. Please click one box to let us know if you would like to receive these updates. *

Yes, I would like to receive email news from Harrow u3a. No email news, thank you.

The Third Age Trust (national body of the u3a movement) also produces a magazine for u3a members. Do you wish to receive these (at no extra cost to you)? If so, we will need to send your name and address to the company that posts them. *

Yes, I wish to receive the national u3a magazine. I understand that my name and address will be sent to the distribution company. No magazines, thank you.

Please let us know if you have any particular interests you hope to pursue in Harrow u3a. Also any skills or expertise you could share in this self-help organisation, or a willingness to volunteer at some point. *

How did you find out about Harrow u3a? *

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