New Membership Form

FLEET AND DISTRICT
University of the Third Age
Membership Application Form - September 2015 to August 2016
New Applications Only
Please complete this form (ticking the appropriate boxes) and send it with your subscription to
the Membership Secretary: 2 Nepal Gardens, Church Crookham, Fleet GU52 8LL
I am a NEW Member
Number allocated ………………….…….
PERSONAL DETAILS (please use BLOCK CAPITALS)
Title: ……………
First name: ………………………………………..……… Surname: …………………………..……………………
Address: ………………………………………………………………………………………………………………………………………………………
Postal Town: ………………………………………
County: …………………………………….. Post Code: ……………………
Telephone Number: ………………………………………………
E-mail address [please print in capitals]: ………………………………………………………………………………………………..
I enclose a cheque
or cash
for the sum of £15 per member [one cheque per person].
Cheques should be made payable to Fleet U3A – please do not send cash in the post.
Gift Aid Declaration
Please treat as Gift Aid donations all qualifying gifts of money made today and in the future
Please tick box if applicable.
I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year
(6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community
Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand
that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p
of tax on every £1 that I give on or after 6 April 2008.
Donor’s details
Title ……………….. First name or initial(s) …………………………………………………………………………………………………….
Surname …………………………………………………………..
Full home address ………………………………………………………….…………………………………………………………………………..
Postcode …………………………….. Date ……………………………….. Signature …………………………………………………………
Please notify the membership secretary if you:
 Want to cancel this declaration
 Change your name or home address
 No longer pay sufficient tax on your income and/or capital gains.
If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due
to you, you must include all your Gift Aid donations on your Self Assessment tax return or ask HM
Revenue and Customs to adjust your tax code.
Office
Use only
Received: ……………………….
Membership Card and Programme posted:
U3A – Application Form for New Members
Entered onto database:
Registered Charity 1055104
Revised May 2015
FLEET AND DISTRICT
University of the Third Age
Membership Application Form Notes
Are You a UK Taxpayer?
If so you can make your eligible membership fees go further by completing the declaration overleaf.
Because Fleet and District U3A is a registered charity [No. 1055104] we are able to treat your
membership fee as a Gift Aid Donation.
Can I claim Gift Aid for my spouse’s membership fee?
Each member who is a taxpayer (even if retired drawing a pension) is entitled to Gift Aid their
subscription to Fleet and District U3A as it is a charity. If you are a couple and you are both
taxpayers then each of you needs to complete the Gift Aid form. However, if one of the couple is a
taxpayer and the other is not we can only claim Gift Aid on the taxpayer’s subscription even if he or
she pays both subscription fees. This is because the HMRC view the payment of a subscription fee for
a non-taxpayer by a tax payer as a gift to that individual not to the charity.
Change in your details
Please notify the Membership Secretary if you change your name, address, telephone number, e-mail
address or your Gift Aid status at any stage in the future.
UK Data Protection Act.
Personal information supplied on this form will be held by Fleet and District U3A on a computer system
and used for administration purposes only.
Thank you!
Membership Secretary
2 Nepal Gardens
Church Crookham
Fleet, GU52 8LL
Email: memsec@fleetu3a.org.uk
U3A – Application Form for New Members
Registered Charity 1055104
Revised May 2015