If you would like to join the U3A Wrexham please complete all the requested details below and our membership secretary will contact you shortly. More Information

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Title	*	MrMrsMsDrMissRevProfOtherOther
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Your email Address	*
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Type of Membership		Select Membership Type Full Member
Primary Telephone Number	*
Secondary Telephone Number
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Emergency Contact
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SECOND MEMBER DETAILS
Title	*	MrMrsMsDrMissRevProfOtherOther
Other Title	*
Forename	*
Family Name	*
Your email Address	*
Repeat email Address	*
Primary Telephone Number	*
Secondary Telephone Number
Emergency Contact Number
Emergency Contact Name
Emergency contact name	*
Emergency Telephone No.	*
		No Yes   Confirm Contact Done
		No Yes   Gift Aid

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