Bedford University of the Third Age

Chairman:   Mike Ward

Registered Charity No 1042458

APPLICATION FOR MEMBERSHIP 2011/2012

Please complete using block capitals.

Title  ...........       Surname.............................. Date of Birth..................

Full Forenames...............................................Known as....................... 

Address..............................................................................................

.....................................................................Postcode......................

Telephone....................................................email.............................

(If you provide an email address, please remember to check your email regularily)

The Third Age Trust

PLEASE ENCLOSE £15 SUBSCRIPTION FEE PER PERSON PAYABLE TO BEDFORD U3A

If you are unable to collect membership badge and new member's booklet from the Open Meetings, please enclose a stamped addressed envelope (A5)

Membership Secretary: Mrs Carol Hipwood, 2 Pershore Close Bedford MK41 8NS

email : carol.hipwood@ntlworld.com          telephone: 01234 406816

I enclose cheque for..£15.......   payable to Bedford U3A

Signed........................................

GIFT AID DECLARATION * delete as appropriate

* I would/would not like Bedford U3A to reclaim the tax on all subscriptions I have made this tax year and may make in the future until I notify you otherwise, as Gift Aid donations.

                Signature:...............................                     Date:...........................

                                          (Do not sign if you do not pay tax.)

1.        You can cancel this Declaration at any time by notifying the Membership Secretary

          in writing

2.        This Gift Aid Declaration covers any payments that you have made to the U3A

          since April 2004  and   may  make   in  the  future,   including  single   donations

          and   membership subscriptions

3.        For your donation to qualify for Gift Aid you must pay an amount of income tax

          and/or capital gains tax at least equal to the amount the Bedford U3A will reclaim

          on your donation within a tax year

4.        If you pay tax at the higher rate you can claim further tax relief in your Self

          Assessment tax return

5.        If in the future your circumstances change and you no longer pay tax on your

          income and capital gains equal to the tax that Bedford U3A reclaims, you can

          cancel your declaration

6.        Please notify Bedford U3A if you change your name or address