U3A Bromley Registered Charity No 803461
APPLICATION FOR MEMBERSHIP RENEWAL,
AND GIFT AID DECLARATION
Please download this page on A4 size paper and using BLOCK LETTERS complete a separate form for each person wishing to renew. Highlight any details which have changed in the last 2 years.
I wish to renew my membership of U3A Bromley and enclose £12 as my subscription to the end of 2012. (Cheques should be made payable to U3A Bromley.) Your personal data will only be used by the U3A
My membership No. is ……………………………………………
TITLE ……......... FORENAMES……………………………................
SURNAME…………………….………............…………………………............…………………
ADDRESS…………………………............…………………………………………………………
…………………………………………………………………………………………………...........
POST CODE………………... ........... TEL. NO………………………………….......................
E-mail address…………………………………….............................................................................
If you are a UK taxpayer and have not previously done so, please consider signing the Gift Aid Declaration below to enable us to reclaim the tax paid. The extra money will help us to fund other activities.
Gift Aid Declaration (Optional)
I would like the U3A Bromley to reclaim the tax on all my membership subscriptions paid on and after the date of this declaration. I confirm that I pay an amount of UK income tax or capital gains tax equal to the tax that will be reclaimed.
Please tick this box 
SIGNATURE………………………………………….. DATE………………
This Declaration can be cancelled at any time by notifying the Membership Secretary in writing. Please notify the membership secretary if a) you want to cancel the declaration; b) you no longer pay sufficient tax; c) you change your address.
If you pay tax at the higher rate you can claim further tax relief in your Self Assessment tax return.
Please enclose a self-addressed envelope stamped second class to:
Evelyn Robinson, U3A Bromley Membership Secretary,45 Blackbrook Lane, Bromley, BR2 8AU
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For Office use only
Membership No…………… Admin No………… Date ………….. Gift Aid …………….