VERWOOD U3A REGISTRATION FORM - 2011 - 2012

Please print clearly and include your post code

 

 

Title (Mr. Mrs. Etc.)……….  Forename…………………………………. Surname……………………………………………........…………………….. Address………………………………………………………………….

Town ...........................................  Postcode………………………

Tel. No……………………………….

Email……………………………………………………………………..

 

Please enroll me in the following classes :-

 

 

Class……………………………………………………………………………..

 

Venue…………………………………  Day………………  Time…………...

 

Class……………………………………………………………………………..

 

Venue…………………………………  Day………………  Time…………...

 

Class……………………………………………………………………………..

 

Venue…………………………………  Day………………  Time…………...

 

Class……………………………………………………………………………..

 

Venue…………………………………  Day………………  Time…………...

 

 

 

I am willing to lead a class on (Subject)…………………………...

 

Enclose  your cheque for £37.50 payable to Verwood U3A and a 9 x 4 stamped addressed envelope, then send to:

Mr. Glyn Roberts U3A Membership Secretary, 37 Albion Way, Verwood, BH31 7LS

 

I understand that Verwood U3A maintains a database of members details for administration which is not disclosed to any outside party.

 

Signature                                                                     Date

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