Your Title

    Surname

    First Names

    Preferred Name

    Suburb/City

    Post code

    Suburb/City

    Post code

    Phone

    Mobile



    Age Group

    Membership fees are $30 per person. Payment by 31st December would be appreciated.

    Account Name: U3A Rockhampton and District Inc BSB: 064710 Account Number: 0092 5452
    Include your name in the description so your EFT payment can be identified by the Treasurer.