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

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Title	*	MrMrsMsDr.MissProf.RevOther
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 Membership Member of another U3A Guest Membership.. Joint Full Member Joint Other U3A
Primary Telephone Number	*
Secondary Telephone Number
Emergency Contact Number
Emergency Contact
Dog Walker?
Additional 2 - 25 char
		No Yes  Additional 3 - Yes / No
		No Yes   Gift Aid
		No Yes   Third Age Magazine
		No Yes   National Trust Member
		No Yes   English Heritage Member
		No Yes   Cadw Member
		No Yes Do you have any needs which we should to be aware of?

SECOND MEMBER DETAILS
Title	*	MrMrsMsDr.MissProf.RevOther
Other Title	*
Forename	*
Family Name	*
Your email Address	*
Repeat email Address	*
Primary Telephone Number	*
Secondary Telephone Number
Emergency Contact Number
Emergency Contact Name
Dog Walker?
Additional 2 - 25 char
		No Yes   Additional 3 - Yes / No
		No Yes   Gift Aid
		No Yes   National Trust Member
		No Yes   English Heritage Member
		No Yes   Cadw Member
		No Yes Do you have any needs which we should to be aware of?

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