If you would like to join the Peterborough U3A please complete all the requested details below and our membership secretary will contact you shortly. More Information

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Title	*	MrMrsMissMsDrRevProfLordLadyOther
Other Title	*
Forename	*
Family Name	*
Please Provide your Post Code	*
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Your email Address	*
Repeat email Address	*
Type of Membership		Select Membership Type FULL MEMBER
Primary Telephone Number	*
Secondary Telephone Number
Emergency Contact Number
Emergency Contact
How you discovered us?
		No Yes   Gift Aid
		No Yes   Third Age Magazine
		No Yes   National Trust Member
		No Yes   English Heritage Member
		No Yes Do you have any needs which we should to be aware of?

SECOND MEMBER DETAILS
Title	*	MrMrsMissMsDrRevProfLordLadyOther
Other Title	*
Forename	*
Family Name	*
Your email Address	*
Repeat email Address	*
Primary Telephone Number	*
Secondary Telephone Number
Emergency Contact Number
Emergency Contact Name
How you discovered us?
		No Yes   Gift Aid
		No Yes   National Trust Member
		No Yes   English Heritage Member
		No Yes Do you have any needs which we should to be aware of?

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