Keep this section
for your own records

Membership Application/Renewal
Cootamundra U3A Inc
to 30 June 2017

Payment made:

$__________________ Cash

$__________________ Cheque

Date _________________

You will be able to participate in as many courses as you wish, subject to vacancies

Depending on the course, there may also be minor additional charges to cover equipment and/or cost of materials

Membership
Application/Renewal
Cootamundra U3A Inc

Please return this section to
the Secretary or Treasurer

Name: (please print)

....................................................................................................

....................................................................................................

Address:

....................................................................................................

....................................................................................................

Email:

....................................................................................................

Phone

....................................................................................................

Mobile

....................................................................................................

Date

....................................................................................................

Membership Fees
1 July 2016 to 30 June 2017

$25.00 (Single) ______; $40.00 (Couple) ______;

Cash ______; Cheque ______;

(Please make cheque payable to Cootamundra U3A)

  • Secretary: Cootamundra U3A
  • PO Box 619
  • COOTAMUNDRA NSW 2590