u3a Takapuna Application Form

Application for Membership

PLEASE PRINT
Name

First NameLast Name
Preferred Name (For Name Tag)
Birth Date

MonthDayYear
Address

Street

Suburb

CityState / Province

Post Code
Home Phone Number

Area CodePhone Number
Mobile Number

021, 027, etcPhone Number
Email
example@example.com
My Personal Interests
Subjects / Hobbies
Study Groups I am interested in joining / creating
Click here to access study groups
My present or previous Occupations (optional)
How did you hear about u3a Takapuna
A Member? Friend? Website? etc
I would prefer to receive my Monthly Newsletter via
Note additional sub for mailed Newsletter
I will pay my subscription
Note additional sub for mailed Newsletter
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Download or Print a Subscription & Newsletter Notice for 23-24 year
Privacy of your personal information

Its important to note that we take privacy of information seriously. The member database is kept secure and we use the well-known cloud-based email management system MailChimp for sending out any emails. We will use our best endeavours to ensure that we only use the member database for U3A Takapuna business.
If you have any questions, please email Murray on news@u3atakapuna.org.nz
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Application for Membership