CUKPA Membership Application

To become a Member please fill in the form below

Member Details
Contact Details
Consents

Member Details

Created by Member, maintained by Member and Memb Sec

First Name*

Last Name*

Birth Year

Retirement Year

Actual or anticipated year

Spouse Name

Full name including surname

Contact Details

Created by Member, maintained by Member and Memb Sec

Email*

If you change your email the old address will still receive email until you unsubscribe

Confirm Email*

Just to make sure!

Address*

Address2

Town or City*

Postal town/nearest city

County/District

Country

If not UK

Post Code*

Format depends on country. Please enter carefully as there is no validation

Phone

Preferably a mobile. Include country code if not UK

Consents

Created by Member, maintained by Member

In Person Events

Yes No

Would you be interested in joining local 'in person' events?

Online Events

Yes No blank

Would you be interested in joining online events such as 'pub' quizzes, talks, pension chats, AGM, etc?

Comment

Anything else you would like to add or any services you would like to see from the Association

GDPR Consent

By becoming a member you are giving consent for the CUKPA to contact you using your contact details. Your details will be used only by the CUKPA for the purposes of providing the services defined in our Constitution and will not be passed to third parties without your permission. All personal details will be deleted at the end of the financial year following notification of termination of membership.

Proof Of Humanity*

4 × 5 = ? Just to make sure you are not a robot¬

Privacy Notice
Your data will be seen and used only by the Committee of CUKPA for the purposes of the Association. It will be held in a secure database and will not be disclosed to third parties or any other member of the Association without your express permission.

If you agree to attend online events, then you are also giving permission to be contacted via whatever platform is used for the event, which will be advised in advance, and by email to advise you of upcoming online events. This can be changed at anytime by updating your Membership Record.