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If you would like to join the Crewe & Nantwich u3a please complete all the requested details below and our membership secretary will contact you shortly.

Tick box to confirm you have read and accept our Terms & Conditions

* denotes a mandatory field

Title	*	MrMrsMsDrMissRevProfOther
Other Title	*
Forename	*
Family Name	*
Please Provide your Post Code	*
		If your address IS NOT in the list then check this box CLICK HERE THEN SELECT YOUR ADDRESS FROM THE LIST	INVALID POST CODE Please correct    Check this box if you believe your post code is correct
Your email Address	*
Repeat email Address	*
Type of Membership		Select Membership Type Full Membership Member of another U3A
Primary Telephone Number	*
Secondary Telephone Number
Emergency Contact Number
Emergency Contact
Age in Years at Joining
How did you hear about us
		No Yes   Gift Aid
		No Yes   Third Age Magazine
		No Yes Do you have any needs which we should to be aware of?

SECOND MEMBER DETAILS
Title	*	MrMrsMsDrMissRevProfOther
Other Title	*
Forename	*
Family Name	*
Your email Address	*
Repeat email Address	*
Primary Telephone Number	*
Secondary Telephone Number
Emergency Contact Number
Emergency Contact Name
Age in Years at Joining
How did you hear about us
		No Yes   Gift Aid
		No Yes Do you have any needs which we should to be aware of?

Complete the sum to prove you are human  =