On Line Application Membership application including second member v2 Revised form to take into account data protection legislation 25 May 2018. Privacy statement added, as detailed in example supplied by Third Age Trust. To apply for membership to the Dorking & District U3A complete this form and click the Submit button. The annual subscription is £16, or £28 for two members at the same address. You can pay online after completing this form (you'll need your bank's sort code and your account number) or by sending a cheque. When your application and your first year's subscription have been received your membership card(s) will be posted to you. Fields marked with an * are required.Do you wish to apply for two memberships at the same address?NoYesName* Title MrMrsMissMsDrProfRev First Last Address* Address 1 Address 2 Town Postcode Email* Phone*Mobile PhoneEmergency Contact Name and NumberHow did you hear about us? Website Newspaper Library Friend Other Please give detailsGroups or activities you are interested in (including any ideas for new ones) Second applicantSecond applicant's name* Title MrMrsMissMsDrProfRev First Last Email (if different from above) Phone (if different from above)Mobile PhoneEmergency ContactGroups or activities you are interested in (second applicant) Name of charity: Dorking & District U3ACharity number: 1005743 Gift Aid helps us to keep subscription rates at an affordable level at no extra cost to you. If you would like your membership subscription to be treated as a Gift Aid donation, please read the declaration below and ensure that Yes is selected. I am a UK taxpayer and I would like Dorking & District U3A to treat my membership subscriptions paid from today, until notified otherwise, as Gift Aid donations. I confirm that the amount of Income Tax and/or Capital Gains Tax that I pay each year is greater than any tax reclaimed.Gift AidYesNo• Please notify Dorking & District U3A if you want to cancel this declaration, if you change your name or home address, or if you no longer pay sufficient tax on your income and/or capital gains. Privacy statement Dorking & District U3A requires members to provide their personal information so that you can be kept informed about events and activities that are offered as part of your membership. In collecting your information Dorking & District U3A will: Store it securely; Use it to communicate with you as a U3A member; Share it with group leaders for those groups that you are a member of; and Send you general information about the Third Age Trust (the national organisation to which U3As are affiliated). Are you happy to be added to the direct mailing list for Third Age Trust magazines Third Age Matters and Sources? If so, please tick the box below.Magazines direct mail I/we consent to my/our data being shared with the company that oversees the distribution of Third Age Trust magazines. • You can request that your data not be used for any of these purposes at any time by contacting the Membership Secretary. On completion you will be redirected to the members' subscriptions page to finalise your application.