If you would like to join the Steyning & District U3A please complete all the requested details below and our membership secretary will contact you shortly.

Tick box to confirm you have read and accept our Terms & Conditions

* denotes a mandatory field

Title	*	MrMsMrsDrMissRevOther
Other Title	*
Forename	*
Family Name	*
Address 1*	*
Address 2
Address 3
Town / City*
Post Code	*
Your email Address	*
Repeat email Address	*
Type of Membership		Select Membership Type Full Membership
Primary Telephone Number	*
Secondary Telephone Number
Emergency Contact Number
Emergency Contact
		No Yes   Gift Aid
		No Yes   Third Age Magazine
		No Yes   National Trust Member

SECOND MEMBER DETAILS
Title	*	MrMsMrsDrMissRevOther
Other Title	*
Forename	*
Family Name	*
Your email Address	*
Repeat email Address	*
Primary Telephone Number	*
Secondary Telephone Number
Emergency Contact Number
Emergency Contact Name
		No Yes   Gift Aid
		No Yes   National Trust Member

Complete the sum to prove you are human  =