COOKRIDGE AND HORSFORTH
Membership Application Form 1st April 2018 to 31st March 2019
If you have an email address you may join online at
Please complete this form and tick all relevant boxes.
First Name ………………………………………………… Last Name ….………………………….………………………….…
Address ………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………….……………… Postcode………………… ..……………….
Tel …….………………………………………… Email ……………………………….………………………………………………………
Emergency Contact (Name and Number)……………………………….…………………………………………………………
Due to new Data Protection Legislation which comes into force in May this year, it is necessary for you to give your consent for your personal data which we store on a system called Wild Apricot, (based in Canada) to be used purely for U3A purposes. WA is currently compliant with EU-US security and is working towards compliance with the new legislation when this comes into effect. We needyour details for the general administration of CHU3A, to send you up to date news, mailings - including the Third Age Matters Magazine, and for Group Leaders to get in touch. This permission is legally required so please make sure you tick the consent box. Your personal data WILL NOT be sold or used for anything outside the U3A.
I consent for my data being used solely for membership purposes as detailed above.
If you pay income tax on your personal pension or other income you are eligible for Gift Aid. This does not cost you anything but as we are a Registered Charity we are able to claim some of your tax back from HMRC. So if you are eligible please consider this and tick the declaration on the form below.
“I want to Gift Aid my donation of £15 and donations I make in the future or have made in the past four years to Cookridge and Horsforth U3A. I am a UK tax payer and understand that if I pay less Income Tax and /or Capital Gains Tax then the amount of Gift Aid claimed on all my donations in the same tax year, it is my responsibility to pay any difference.”
By ticking this box you are agreeing to Gift Aid and that your name and address may be passed to HMRC.
Photographs may be taken at events or in Groups. Please tick if you are happy for these to be used on U3A sites or publications.
Signed …………………………………………………………………………… Date ......
Thank you for your interest in Cookridge and Horsforth U3A. Please return this completed form together with a cheque for £15 made payable to Cookridge & Horsforth U3A to The Membership Secretary, 36 Wynford Rise, West Park, LEEDS, LS16 6HX. Please include a first-class stamp for return of your membership confirmation and New Member Information Pack.