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 (Term 3 starts Monday February 1)

(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..................................................................
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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?..............................................................................................
----------------------------------------------------------------------------------------------------------------------------- I hereby apply for membership of U3A Cranbourne and agree to comply with the rules of the organisation and with any other terms and conditions as may be determined by the Committee. SIGNED: DATE:
Please note that there are no refunds on membership fees.
Annual membership fee for full year to June 30 2021: tba
Joining in 1st term July-Sept: --
Joining in 2nd term Oct-Nov: -- Joining in 3rd term Feb-March: $10 Joining in 4th term April-June: $10
Already a current U3A member of another U3A - $10 at any time join as an associate.