U3A Nepean - Blue Mountains - Chifley Chapter Inc.
(Incorporated under the Association Incorporation Act 1984)
MEMBERSHIP APPLICATION FORM
(Please print clearly)

 TUTOR   NEW MEMBER   RENEWAL Membership No. ____________

FAMILY NAME: _____________________________________   GIVEN NAMES: ____________________________________________

ADDRESS: __________________________________________________________________________________________________

PC: ____________   PHONE: ___________________________  EMAIL:_________________________________________________

I hereby apply to become a member of the above named incorporated Association. In the event of my admission
as a member, I agree to be bound by the constitution of the Association for the time being in force.
I enclose $30.00 being the annual membership subscription at this time. I acknowledge that subscription fees
will not be refunded if I withdraw my membership, unless my nomination is declined by the Committee.

SIGNED: ___________________________________   DATE: ____________________________

PLEASE TELL US ABOUT YOURSELF
Would you like to receive your newsletter by Email?      YES       NO

What skills/experience/qualifications have you gained from your work/education/hobbies?

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

What was your major occupation? ___________________________________________________________________________________

Do you have a current course list?      YES       NO

Are there any other topics or subjects, not on our course list, which you would like to pursue?___________________________________

______________________________________________________________________________________________________________

Any topics for which you would like to act as Course Leader? ______________________________________________________________

______________________________________________________________________________________________________________

Could you give occasional assistance in our office?      YES       NO

Where did you hear about U3A? (Please tick)
 Radio   Newspaper  Pamphlet/Poster
 Library   Word of Mouth  Other

Annual membership:   $30.00
Please make your cheque/money order payable to U3A NEPEAN - BLUE MOUNTAINS.
OFFICEUSE
M/S #Receipt #
  
  
Entered 
Issued 

COMPUTER ENROLMENT FORM

Name: _____________________________________________

Address: __________________________________________

___________________________________________________

Phone #: _____________________ U3A #: ______________

Email: _____________________________________________

 

PREFERRED COURSE OR COURSES
Number your preferences (1,2,3,4)

ABasic Computing: Robert Byrne
BComputers—First Contact: Elly Byrne
 Basic Computing (Other tutors)
 Computers—Advanced Work: Jim Percy
 Term 1        Term 2        Term 3        Term 4