New members should download this form on A4 size paper, complete and return it to
the address below.
Using BLOCK LETTERS please complete a separate form for each person
wishing to join the U3A BROMLEY.
I wish to become a member of the U3A Bromley and enclose £10 as my subscription
up to 31st December 2008. (Cheques should be made payable to U3A Bromley)
TITLE................................FORENAMES........................................................................
SURNAME.......................................................................................................................
ADDRESS and POSTCODE.............................................................................................
..........................................................................................................................................
..........................................................................................................................................
TELEPHONE No. and E Mail (if appropriate)..................................................................
INTERESTS.....................................................................................................................
.........................................................................................................................................
If you are a UK tax payer,every £1 of your membership fee is worth £1.28 to us because we
are a Charity. This extra money can help fund our activities. Please complete and sign the Gift
Aid Declaration below so that we can reclaim the tax. If you pay tax at the higher rate you can
Claim further tax relief in your Self Assessment tax return. This declaration can be cancelled
at any time by notifying the Membership Secretary in writing
Gift Aid Declaration
I would like the tax to be reclaimed on this membership subscription and any future
subscription that I make to the U3A Bromley until further notice. I confirm that I pay an
amount of UK income tax or capital gains tax at least equal to the tax that the U3A Bromley
will reclaim..
I also agree to my details as listed above being entered on a computer database for the exclusive
use of U3A.
SIGNATURE..............................................................................DATE................................
Please enclose an A5 (240 X 165mm) self-addressed envelope stamped with both a 1st
and 2nd class stamp to - Evelyn Robinson, U3A Membership Secretary,
45 Blackbrook Lane, Bromley BR2 8AU
............................................................................................................................................
For office use only
Membership No................................Admin No.........................................Date..............
RETURN TO HOME PAGE
U3A BROMLEY NEW MEMBERS APPLICATION
FORM, AND GIFT AID DECLARATION.
Reg. Charity
No. .803461