Membership Form 2021 – U3A Central Coast Tasmania

Name *

First

Last

Email *

Address *

Mobile or Home Phone *

I agree to be bound by the Constitution and Rules of University of the Third Age Central Coast (Tas) Inc.". *

Signature *

Date *

Membership Fee for 2021: $ 40.00 per annum - I wil pay by: *

Cash
Cheque
EFT

(A) You may return this form, with payment, by mail to U3A, 3 Gollan Street, Ulverstone TAS 7315. ( Cheques should be made payable to "U3A Central Coast (Tas) Inc".) OR (B) By email, to u3acentralcoast@gmail.com (with payment by EFT). Please note that we do not have credit card or EFTPOS facilities. EFT Details - Account Name: U3A Central Coast, BSB: 632001, Account Number: 100174864. If paying by EFT, please put your name in the "description" box of the payment. Please INDICATE ABOVE how you are paying (Cash/Cheque/EFT).

OFFICE USE

Member Number / Receipt Number