UNIVERSITY OF THE THIRD AGE

THE THIRD AGE TRUST

Calpe, Levante

MEMBERSHIP FORM

2008/2009

Please PRINT clearly the following information:

Post Code  __________________

Tel No.________________________     Mobile No.    _____________________________

Email: ____________________________

My main interests are: __________________________________________________

____________________________________________________________________

I would be interested in leading a group(s) in the following:-  ___________________

____________________________________________________________________

I fully understand that I partake in any activity at my own insurance risk and that membership is renewable each April.  I agree to comply with all terms and conditions of membership.

Signed:   _________________________             Date:   _______________________

For Office Use Only:            Receipt No.___________  Membership No. _________________

To contact Gill Moorcroft, Membership Secretary, Tel 96 574 8153 or e-mail: