Membership Application Please fill in the form below or download the PDF version, fill it in and send it to the address on the PDF. Family Name:(Required)Given Name:(Required)Address:(Required)Suburb:(Required)Postcode:(Required)Phone:(Required)Email:(Required) Emergency ContactsName:(Required)Phone:(Required)Please note the 2 questions below is for insurance purposes only and your privacy will be respected.Do you have a disability? Yes No Are you 95 years or over? Yes No Membership InformationMembership Fee - $30 per year. (If you join on or after the 30th September you will be financial until the end of the following year) Payment option available is via direct payment online. Bank details are provided at the bottom of this page and on the confirmation email. Membership Price: Class informationFor information about classes please email - secretary@u3aherveybay.net or phone 0431 366 264I would like to be enrolled in the following classes:1:2:3:4:5:6:NB: Your enrolment is subject to number availability. Please contact the relevant class tutor for confirmation.Tutor InformationWould you like to be a Tutor? Yes No If you answered yes to being a tutor, what subject could you offer?How did you hear about U3A Hervey Bay?Applicant's AgreementDate:(Required)Confirmation(Required) By ticking this box you agree to the terms of the constitution, policies and by-laws of U3A Hervey Bay Inc.I agree to the terms of the constitution, policies and by-laws of U3A Hervey Bay Inc. I acknowledge that I have read the terms of the constitution, the policies and the by-laws of U3A Hervey Bay.
