If you would like to join the Holmes Chapel & District 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	*	MrMrsMsDrMissOther
Other Title	*
Forename	*
Family Name	*
Housename and/ or Number	*
Street / Road Name	*
Town/ Village	*
County	*
Post Code	*
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
How did you hear about us
What skills can you share
		No Yes   Gift Aid
		No Yes   Third Age Magazine
		No Yes   National Trust Member
		No Yes   English Heritage Member
		No Yes Do you have any needs which we should to be aware of?

SECOND MEMBER DETAILS
Title	*	MrMrsMsDrMissOther
Other Title	*
Forename	*
Family Name	*
Your email Address	*
Repeat email Address	*
Primary Telephone Number	*
Secondary Telephone Number
Emergency Contact Number
Emergency Contact Name
How did you hear about us
What skills can you share
		No Yes   Gift Aid
		No Yes   National Trust Member
		No Yes   English Heritage Member
		No Yes Do you have any needs which we should to be aware of?

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