VERWOOD U3A REGISTRATION FORM - 2010 - 2011

Please print clearly and include your post code

 

 

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

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

Tel. No…………………………….

Email…………………………………………………………………..

 

Please enrol 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 £35.00 payable to Verwood U3A and a 9 x 4 stamped addressed envelope, then send to:

Mrs. Sue Cheese, U3A Membership Secretary, 1 Mandalay Close, Verwood, BH31 6LR

 

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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