Pewsey Vale u3a Membership Form
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Email *
Preferred title (Mr, Mrs, Miss, Ms, Other)
First Name and Last Name *
Address *
Post Code *
Preferred Phone Number *
Alternative Phone Number
Can you provide an "In case of Emergency" contact name and telephone number? If you can let us know who this is (partner, son, daughter or friend, that would be helpful too). Please can you ask their permission to give out their number, before filling this in. Should there be an accident or emergency involving you at any u3a event we can contact this person, if appropriate. If you do not wish to leave an "In case of Emergency" contact name and telephone number, please leave this section blank.
I am no longer in full time employment *
Please enter your full name as your signature to this application. A copy will be emailed to you once your application has been processed. *
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