Registration

NORTH WEST LONDON

UNIVERSITY OF THE THIRD AGE

Registered Charity 1051027

REGISTRATION FORM

When registering by post
please send the completed form, together with the fee to:-

THE HON. TREASURER, NW LONDON U3A,
32 LAKE VIEW, EDGWARE, MIDDX HA8 7RU

PLEASE COMPLETE THIS FORM USING BLOCK CAPITALS

SURNAME .......................................................................................... FIRST NAME.................................... TITLE.............

ADDRESS...................................................................................................................................................................................

POSTCODE..................................................... TELEPHONE........................................ email............................................

If this is your first application to join NW London U3A please tick here

"I enclose £18, being my membership fee to join North West London U3A
for the two terms commencing January 9th 2012
(if attending an Art group please add £10)
Please make your cheque payable to ‘North West London U3A’

I am Interested in attending the following courses
(this does not involve any firm commitment, it is simply to assist with planning)

.........................................................................................................................................................................................................

I am interested in forming / leading a study group (state subject)

I am willing to help in the running of NW London U3A

FOR OFFICE USE ONLY

Amount received £................................Cheque / Cash................................... Date received................................................

Membership receipt number.............................................. Computer ref..................................................................

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