Lostwithiel Area U3A
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Membership application form

Please use this form to apply for membership of Lostwithiel U3A without using a credit card or PayPal.

Alternatively you can register and pay for membership with a Credit / Debit Card.

Please complete all mandatory fields marked *
Your title *
Your first name *
Your last name *

Second Applicant

Name of Second Applicant if you are applying for Joint Membership. (Leave blank for single membership)
Second person title 
Second person first name 
Second person last name 
Second person mobile number 
Second person email address 

Contact details

N.B. To save costs, the committee will use email whenever possible.
Email *
Landline phone number 
Mobile phone number 
Address line 1 *
Address line 2 
Town/village *

Ways we contact you

Please let us know how you would like to be contacted by Lostwithiel Area U3A
Are you happy to receive communications by email? *

Are you happy to receive communications by landline telephone? *

Assuming you have provided your mobile phone number, are are you happy to receive communications including texts? 

Are you happy to receive communications by post? *

Are you happy to be added to the direct mailing list for the our National Organisation The Third Age Trust? This involves your name and address being shared with the company that oversees distribution of Third Age Trust Magazines? *

Please be advised that you can request for your data not to be used for any of these purposes at any time by contacting Lostwithiel Area U3A.

Emergency contact

Please supply the name and phone number of a person we can contact in the event of any emergency.
First name 
Last name 
Phone number 
I apply for membership of Lostwithiel U3A and confirm that I will comply with the terms and conditions of membership *
Please add any other questions or comments in this box