Annual Fee Form

Annual Fee Form

U3A Okeover 2024


Please hand your enrolment form to the treasurer at the desk if he is available.

Your Name(s):

You can use this form for the annual fee for one or two members.

Enter member name(s):
Member 1
Member 2

 

Annual Fee

Annual Membership ($25.00 )

Payment

Total Due
__________

Payment Method

x
Via Internet or Phone banking into account No 03-1594-0108506-00 (Please ensure you enter a surname and initial)

Questions/Comments:


Your Contact Details

Please provide your contact details, so that we can contact you in relation to this application:

Name:

Email:

Complete these details only if they have changed:

Address:


Post Code:


Phone:

Emergency Contact:

Emergency Phone:

Signature: