Membership Application/Renewal/Enrolment Step 1 of 3 33% Section 1 – NameName(Required) First Middle Last Preferred Name(Required) Year of Birth Section 2 – AddressPostal Address(Required) Address Line 2 City State ZIP / Postal Code Residential Address (if different to postal) Street Address Address Line 2 City State ZIP / Postal Code Section 3 – Contact DetailsEmail Enter Email Confirm Email Mobile Phone Home Phone Section 4 – Emergency Contacts1st Emergency Contact Phone Alternative Phone (if applicable) 2nd Contact (if applicable) Phone Alternative Phone (If applicable) Section 5 – U3A MembershipDo you belong to another U3ANoYesU3A Name Section 6 – EnrolmentMonday Ramblers (9:30 Start (F)) Fun Board & Card Games (1:30 – 4:00 (F)) Art Group – Imagine (2:00 – 4:00(W)) Tuesday Chair Dancing (9:30 – 10:30 (W)) Italian Conversation (10:30 – 11:30 (W)) Continuing Tai Chi FULL (10:30 – 11:30 (W)) Ukes & Company (10:45 – 12:15 (W)) Learn to Play Guitar (1:00 – 2:00 (W)) Book Club FULL (12:30 – 2:00 (First Tuesday of Month) Intermediate Line Dancing FULL (1:30 – 3:00 (W)) Wednesday Discussion Group (10:00 – 12:00 (F)) Intermediate Tai Chi (10:30 – 11:30 (W)) Harmonica (10:30 – 12:00 (W)) * Improvers Line Dancing (12:30 – 2:00 (W)) Men’s Group Coffee & Chat (1:30 – 3:00 (F)) Jam Along (1:00 – 3:00 (W)) Craft Circle (1:30 – 3:45 (W)) Thursday Shibashi (Exercise) & Tai Chi Practice (10:30 – 11:30 (W)) * Bell Chimers (12:30 – 1:45 (W)) Puzzle Power (1:00 – 2:30 (W)) Scrabble (1:30 – 4:30 (W)) Book Club FULL (7:00 – 8:30pm (Last Thurs of Month) Friday Craft & Leisure Group (9:00 – 11:30 (W)) Mah Jong (10:00 – 12:00 (W)) Creative Writing (10:00 – 12:00 (W)) Sjoelen (Dutch Shuffleboard) (1:30 – 3:00 (F)) Section 7 – PaymentMembership Type(Required)Full Single Membership – $40Household Membership – Two members at same address – $70Half Year Membership – (Terms 3 & 4) – $20Term 4 Membership – $10Other U3A Member – 50% of applicable feePlease select the payment method(Required)Paid by Direct DepositPaid by ChequeCash PaymentIf a cheque payment please provide the cheque number Submit FormCAPTCHA Δ