U3A in Bath     MEMBERSHIP FORM
See notes below First Person Second Person
Title
First or Preferred Name
Surname
Mobile No
Any Relevant Skills
Skills (continued)
Address 1
Address 2
Town/City
Post Code
Newsletter Email or Post
Gift Aid Declaration ( see note below )
I am a UK tax payer and I want the U3A in Bath to treat this and future subscriptions until further notice as Gift Aid Donations.

Signed

Date

I am the    FIRST   /   SECOND    person.
E-mail Address
Home Phone Heard of us from?






Notes

• Please send the completed form with a cheque payable to U3A in Bath for £12 or £20 to -
    Membership Secretary, U3A in Bath, PO Box 4040,
    Bath, BA1 0EJ

• Gift Aid Declaration: If you are a tax payer (Income Tax or Capital Gains Tax paid to the Inland Revenue, PAYE deducted from earnings or pension, or tax deducted from dividends or other interest received) , please ensure that you have signed the Gift Aid Declaration on the printed form. In the case of a joint subscription, if only one member is a taxpayer then that member should complete the declaration. Please indicate whether the person signing is the first or second person on the form in case we cannot read your signature.