TUGGERAH LAKES U3A Inc

APPLICATION FOR RENEWAL OF MEMBERSHIP

for year ending 31^st December 2012

Please Print and return Application together with fee to:

The Treasurer,

Tuggerah Lakes U3A Inc.,

4 Sir Joseph Banks Drive

Bateau Bay, NSW 2261

Mr/Mrs/Miss/Ms/Dr: ………………..

First Name:              …………………..………Preferred 1^st Name……………. ……….

Surname:                 ………………………………………………………………………..

Address:                  ………………………………………………………………………….

…………………………….…………………………………………..  Postcode: .……….

Telephone: Home:  ……………….…………….  Business: …………………………….

E-mail address:      …………………………………………………………………………

Emergency contact number (if any):  ………………………………………………………

I hereby apply to renew my Membership of Tuggerah Lakes U3A Inc

and agree to abide by the laws of the organisation.

Signature ……………………………………………          Date: ………………………..

Membership year is 1 January to 31 December

ANNUAL FEE (Renewal):  $20 

Office use only:    

Membership No

Receipt No

Date

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