u3a Membership Application

Dereham u3a Membership Application

Please select the type of membership you require

	Associate	£13.00	Member of another U3A
	Full	£17.00	Main U3A Membership
	Full and Magazine	£21.20	Main U3A membership plus quarterly U3A magazine
Membership paid today continues until 1st April 2027

About You

Title

Forename

Known as

Surname

Verify Email

Mobile

Emergency contact (Name and ‘phone number)

Upload photo (optional)

jpg, png, gif. Recommended max size 2MB

Provide a square format image (aspect ratio 1:1) as other formats will not suit the membership card layout

Own U3A (where you are a full member)

About Your Partner

Title

Forename

Known as

Surname

Verify Email

Mobile

Emergency contact

Upload photo (optional)

jpg, png, gif. Recommended max size 2MB

Your Address

House no/name

Street

Additional line 1

Additional line 2

Town

County

Postcode

Home telephone

Payment

Amount to pay:

Press the button below to proceed to payment options
You may pay by credit or debit card or use a PayPal account

After payment, you should receive an email from PayPal as a receipt and an email from Dereham u3a to confirm membership

The data you provide will be held electronically by Dereham u3a to facilitate your membership.
If you have any concerns, please contact the Membership Secretary.

Problems or Enquiries?: norma.haynes@tiscali.co.uk