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Browns Bay U3A Inc
Membership Manager
PO Box 35 851 
Browns Bay,  Auckland  0630 

The annual subscription is payable  AFTER  the application is accepted.
Do not send money at this stage. 
 
Applicant  __________________________________

Address: ___________________________________

Area code: ____________   

Phone: ___________________    

Email: __________________________________________

Where did you find out about U3A? ______________________________

Name (1) Which Special Interest Groups do you intend joining?

___________________________________________________

Name (2) Which Special Interest Groups do you intend joining? 
 
  ______________ _______________ ___________ ___________ 
  
  Do you have any particular skills or interests you would be willing to share with others? 

  ____________________________________________________

Annual subscriptions: Single $30 ( Plus an initial joining fee of $5 )  _________
 
 
Sign Here:______________________________ Date ____________