Application for Membership - Cranbourne U3A Inc
Application for Membership
Application for Membership - Cranbourne U3A Inc
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CRANBOURNE U3A INC.
Ref: A0047412F ABN: 19 509 123 056
3/65 Berwick Cranbourne Road, Cranbourne, Vic 3977
Phone: 03 5995 0311 Fax: 03 5995 0411 eMail: u3acranbourne@bigpond.com
APPLICATION FOR MEMBERSHIP
(It would help us if you would PRINT your personal details).
Please note all personal information is Confidential and is only required for our U3A records.
Title: _____ Family Name: ______________________ Given Names: ____ _________________________
Preferred Name for Name Badge:________________________
Address: _______________________________________________________________________________
_____________________________________ Postcode: _ ________________________________________
Phone: (Home) _______________________________ Mobile: ____________________________________
Date Of Birth: ________________________________ Country of Birth: __________________________
Email: ________________________________________
Willing to receive newsletters and correspondence by email? Yes No
In case of Emergency - Contact Name: ________________________ Phone: _______________________
Previous Occupation/s, Experience: (Optional) ________________________________________________
Academic or other qualifications:(Optional) __________________________________________________
Do you have any special needs? eg. large print, hearing etc. _____________________________________
_______________________________________________________________________________________
What Course/Interests/Activities, would you like to be involved in? (Also include any ideas for subjects/activities not currently available.) ___________________________________________________________________
_______________________________________________________________________________________
Leadership/ Volunteering: Would you be prepared to act as tutor/discussion leader, or as a volunteer helper?
If so, in what areas? ______________________________________________________________________
How did you hear about ‘Cranbourne U3A Inc’? ____________________________________________
Membership Fee: $50.00, Joining Fee $5.00.
Cash or Cheque (Made payable to ‘U3A Cranbourne Inc.’) NB: Our U3A year is 1st July to 30th June.
Application: I hereby apply for Membership of ‘U3A Cranbourne Inc.’, and agree to comply with the principles defined in the Statement of Purpose and with any other terms and conditions as may be determined from time to time by the Committee.
SIGNED: __________________________ DATE: ________________________
OFFICE USE ONLY: DATE PAYMENT RECEIVED: _______________ BY: ___________________
AMOUNT RECEIVED: _________________________ RECEIPT No: ___________________________
MEMBERSHIP No: _____________________________ NAME BADGE ISSUED: __________________
