Cyprus Third Age (C3A) - New Membership Application Form

Cyprus 3rd Age (C3A) New Membership Application Form

Please complete and submit this form with your €10 subscription

A second application form must be completed for a Spouse/Partner/Companion
If you use WhatsApp and have a query about C3A before filling this form please:
Family Name (Surname)*
Forename(s)*
Mr, Mrs, Miss, Ms, Other*
Title
Date:*

DayMonthYear
Date of application
Postal address*
Field will expand as necessary
Telephone (Landline - optional)
Only if available?
Mobile*
Email address*

Confirmation Email
Previous occupation(s)
Field will expand as necessary
Special interests that you would like to pursue
Field will expand as necessary
Languages spoken
Field will expand as necessary
Skills or knowledge that you would be able to share or capacity in which you are willing to help
Field will expand as necessary
Other relevant information (e.g. Previous C3A or U3A experience)
Field will expand as necessary
Where did you hear about C3A?*
Field will expand as necessary

Annual subscription fee : €10

(Renewals due annually in November)
How would you like to pay your subscription?*

Credit/Debit Card (Preferred method)**Bank Internet TransferPost a cheque
When paying by Credit or Debit card the Card processing fee will be added to the total

Our secure Card processor is Stripe (Cyprus) Ltd.
The C3A does not, at anytime, see your card details
Your Credit/Debit card subscription will be €10.41 (€10 + €0.41c processing fee)

Please enter the subscription fee of €10.41 into the Card payment box below
Bank Transfer Payment Reference*

Payment by Internet Transfer or 'Over the Counter'

The membership joining fee is €10.00

If paying by 'Internet Bank Transfer' or 'Over the counter' at any Bank it is essential that you complete the payment reference box above so that we can identify your payment.

- there is no requirement to send anything by post.

Account name: Cyprus Third Age (C3A)

Bank name: Hellenic Bank

Branch Address : 63 Kremastis Rodou Street, 4620 Episkopi, Limassol

Account number: 285-01-G46362-01

IBAN: CY96 0050 0285 0002 8501 G463 6201

SWIFT: HEBACY2N

** Bank of Cyprus & Hellenic Bank do not charge for internet bank transfers to the C3A account - transfer fees from other banks may vary.
Annual subscripton fee: €10.00

Cheques payable to: Cyprus Third Age (C3A)

If paying by cheque after clicking 'Submit' please print and enclose a copy of the .pdf membership form which you will receive attached to your acknowledgement email - together with your cheque for your Subscription or Membership

The Treasurer, C3A Limassol, PO Box 51922, 3509 Limassol

Please do NOT send cash in the post OR send cheques by registered or recorded delivery.

Credit/Debit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Disclaimer

Participaton in C3A activities is undertaken at the member’s own risk and neither C3A nor Group Leaders are responsible for any injuries/mishaps however occasioned.
Confidentiality

I understood that I am giving C3A permission to store my name, address, telephone and email details. The C3A guarantees that these details and any other personal information you provide to us WILL NOT be divulged to ANY third party without your prior consent (except as required by the laws of the Republic of Cyprus) and will be securely deleted when you cease to be a member of C3A.
Declaration

I have read and understand the disclaimer & confidentiality statements above and agree to comply with the Cyprus Third Age Constitution, its Aims and Guiding Principles and Regulations which are also available on request.

IMPORTANT NOTE

By clicking the Submit button below you are signifying your consent

to both the Disclaimer and Confidentiality clauses shown above.
Cyprus Third Age Registration no. 3246
Please use your mouse to sign in this box - or if you are using an 'active screen' device (e.g. tablet or smart-phone) a stylus or your finger

Signature box Clear
Please read the whole of this section carefully BFORE clicking the Submit button

You now have 3 choices :

1. You can click 'Preview PDF' to view the completed Application form.

2. You can click 'Save' which will allow you to return to complete the form later.

3. You can click 'Submit' which will send your Application for membership to us and also - if you have elected to pay by Credit/Debit Card - process your payment.

After clicking 'Submit' you will receive an automated acknowledgement/Payment receipt email with a PDF copy of your completed Membership Application form attached.

- if you are UNABLE to complete the online signature box above

please print and sign this form

then either :

1. Scan your signed membership form and send it to : c3a.cyprus@jetnet.co.uk

OR

2. Send it by post (together with your €10 Membership fee IF you are paying by cheque) to the C3A Postal Address which you will find both in this online form and in the completed Application form which will be attached to your automated acknowledgement email.

If you don't receive an email please check your Spam folder!

- to confirm your membership we MUST have received the signed form!

It will also send us an UNSIGNED copy of the form which will simply give us a 'heads up' to expect your signed and completed form to arrive by email or in the C3A Post Box in due course!
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