U3A  Castlemaine  Inc.          (for office use)   Membership No____

 Application for Membership

*Surname: ...................................................................*.First Name:...................…...........….…..

 Preferred name for name badge:................................................…..…...*.Mrs/Mr/Ms/Miss....…...

 *Date of Birth:...........................................….Telephone………….………..….............................

*Home Address:............................................……...................................... *PostCode.............….

 Email Address………………………………@…………………………………………..................

 *Name & Telephone Number of contact person in case of emergency………………………………

 Do you speak a language other than English at home                   YES / NO   …………

 Previous Occupation ………………………………………………………………………………....

 My interests are (Please include all your interests……………………………………………………

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 Do you wish your newsletter to be mailed to you (an extra fee of $6 applies)?                   YES / NO

 Do you wish to receive your newsletter via email?                                                           YES / NO

 Do you belong to any other U3A?                      YES / NO                    U3A   …………………………….

 Do you have a membership number or receipt?   YES / NO                     No. ........………….                                                                   

 I agree to allow my telephone number and email  address to be disclosed to other members within the Organisation.

 *Signed:......................................................……………………………..…..*.Date:....................

Mail or hand to: Secretary, U3A Castlemaine Inc.P.O. Box 792, CastlemaineVic 3450

Annual Subscription: $35 + optional $6 extra to have newsletter mailed.   

Persons joining after June 30 will pay 50% of the annual subscription.

ITEMS MARKED  *  MUST BE FILLED IN

PRIVACY STATEMENT This organisation respects your right to information privacy.  Information we collect and hold on members is kept in accordance with information privacy laws.