alison form | KK Custom Form Demo

Class Enrolment

First Name ( required )

Last Name ( required )

Membership Number ( required )

Telephone

Please choose your class category

Please choose your art and craft class:

Please choose your board / card game class:

Please choose your history & philosophy class:

Please choose your language class:

Please choose your music class:

Please choose your poetry and prose class:

Please choose your science and technology class:

Please choose your sport, keep fit or dance class:

Please choose your varied interest class:

Please choose your summer activity class:

Add a second class? ( required ) YesNo

Please choose the category for your second class:

Please choose your art and craft class:

Please choose your board / card game class:

Please choose your history & philosophy class:

Please choose your language class:

Please choose your music class:

Please choose your poetry and prose class:

Please choose your science and technology class:

Please choose your sport, keep fit or dance class:

Please choose your varied interest class:

Please choose your summer activity class:

Add a third class? ( required ) YesNo

Please choose the category for your third class:

Please choose your art and craft class:

Please choose your board / card game class:

Please choose your history & philosophy class:

Please choose your language class:

Please choose your music class:

Please choose your poetry and prose class:

Please choose your science and technology class:

Please choose your sport, keep fit or dance class:

Please choose your varied interest class:

Please choose your summer activity class:

Add more classes? Type them in this box.

List alternative choices if desired:

Are you paying for one or two terms? ( required ) One TermTwo Terms

Please choose how you would like to make your payment: Bank TransferCheque

Your reference should be your initials and the first 3 letters of surname, your membership number plus the letter and number of the class. A separate payment will need to be made for each class you join.

Payment to U3A
Sort Code 40-25-10
Account no 34017021

Please make cheques payable to Huddersfield & District U3A and send to:
U3A, Aspin House, Block B, Station Road, Huddersfield, HD2 1UT

These details will also be on the email you will receive after you submit this form.

Note:

The information supplied by you on this form will be recorded on the Huddersfield and District U3A database at our offices. No information from the U3A files which could identify any individual members will be disclosed to any unauthorised persons. For more information see our privacy policy on thi8s website.

After submitting this form you will receive an email confirming your request. After payment is received the U3A office will contact you to confirm your place(s).

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