Application for membership

U3A CRANBOURNE Inc. 
Ref: A0047412F   ABN: 19 509 123 056
Buildinng 01 - 65 Berwick-Cranbourne Road, Cranbourne East 3977
Phone: 03 5995 0311               Fax: 03 5995 0411
Email: u3acranbourne@bigpond.com
---------------------------------------------------------------------------------------------------------------------
APPLICATION FOR MEMBERSHIP
(please PRINT your personal details)
All personal information is CONFIDENTIAL and is only required for our records.

Title........   Family name:..............................................Given names:............................................
Preferred name for Name Badge......................................
Address:..........................................................................................................................................
..................................................................................................Postcode........................
Home phone:............................................. Mobile:.......................................
Date of Birth:...............................................    Country of Birth:.................................................
Email:..........................................................................................................................................
Would like to receive Newsletters and correspondance by email:  YES  or NO (circle reference)
In case of an Emergency - Contact Name:............................................Phone:.............................
Previous occupations/experience (optional)...................................................................................
.....................................................................................................................................................
Academic or other qualifications (optional)...................................................................................
Do you have any special needs? eg large print, hearing etc.......................................................
...................................................................................................................................................
What Course/Interests/Activities from our current list would you like to be involved in? Also include any ideas for subjects or activities not currently available..................................................................
...........................................................................................................................................................
Leadership/Volunteering: Would you be prepared to act as a Tutor or Leader or as a Volunteer helper? If so, in what areas?...........................................................................................................
How did you hear of U3A Cranbourne?..............................................................................................
-----------------------------------------------------------------------------------------------------------------------------
Joining fee: $5 (covers cost of badge)
Annual membership fee for full year to June 30: $50 + joining fee
Joining in 3rd term July-Sep: $50 + joining fee - paid up to June
Joining in 4th term Oct-Nov: $40 + joining fee - paid up to June
Joining in 1st term Feb-March: $30 + joining fee - paid up to June
Joining in 2nd term April-June: $20 + joining fee - paid up to June
Already a current U3A member of another U3A - $20 at any time as an associate.