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Membership Application Form
Please fill out your details to apply for membership.
Title
*
Please Select
Mrs
Mr
Ms
Dr
Name
*
First Name
Last Name
Name known by
*
e.g. Dot for Dorothy or Jim for James etc.
Address
*
House Name / Number
Street Address
Town
State
Post Code
Phone Number
*
Please enter your phone number.
Format: 0000-000-0000.
Email Address
*
Confirmation Email
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Number
*
Please enter your Emergency Contact's phone number.
Format: 0000-000-0000.
Please Click the appropriate Box below for your subscription method. Currently £25 annually. One of the three Membership Subscription boxes must be checked.
I have transferred my Subscription to Name: Banbridge District u3a, Acc. No: 80261866, Sort Code: 950679 (Danske Bank)
I have Paid my subscription to a Committee Member
I will bring my Subscription to the next General Meeting (See Home Page)
Submit Application
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