New Membership Application

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New Membership Application

Submitted by Visitor on Fri, 10/09/2009 - 09:24

Please fill out the following details to apply for membership.

It is important to note that once you complete this form, you must send in payment for your application manually. Postage details are at the end of this form. You also have the alternative to print out this form and send in payment with the completed details.

Membership details

Membership Class: *

Full - $42

Joint - $37 (each)

Associate - $32

Joint refers to each couple at the same address.
Associate refers to a full member of another U3A.
Full membership refers to anyone else.

If associate, what is your principal U3A?:

Personal Details

Family Name: *

Given Names: *

Preferred Name:

Address: *

Postcode: *

Phone (land): *

Phone (mobile):

E-mail: *

Sex: *

Male

Female

Year of Birth: *

Country of Birth:

Emergency Contact Details

Emergency Contact: *

Relationship: *

Phone: *

General Information

Occupational Background:

Interests & Pursuits:

How did you find out about us?:

Language spoken at home:

Eg. Spanish, Cantonese

Willingness to Volunteer: *

Acceptance of terms: *

By ticking this box, I agree that I am 50 plus and no longer working full time.

Payment: *

No credit card facilities are available. Make cheques payable to 'U3A City of Melbourne Inc.' If posting, please include a stamped, self addressed envelope for receipt and card. Donations are gratefully received (but unfortunately are not tax deductable).

You will still need to mail the payment in before we can process your membership.

Mail to:
U3A Melbourne City
Ross House
247 Flinders Lane
Melbourne, 3000
VIC

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