Pewsey Vale u3a Membership Form
Please complete the information below. Please note that any Google account information shown will be ignored when this form is submitted. Google sign in is NOT required.
The email address you use here should be your main preferred email address.
Sign in to Google to save your progress. Learn more
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 *
Required
Please enter your full name as your signature to this application. A copy will be emailed to you once your application has been processed. *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy