Application for Enrolment on the Church Electoral Roll


Name:*
Address:*
Postcode:*
Telephone:*
E-mail address:
I declare that I am Baptised:*
Yes
No
And I am either::*
Age 16 or over
Or become 16 on::
I declare that (please tick only one box from options A, B or C)::*
A. I am a member of the Church of England (or of a Church in communion with the Church of England) and am a resident in the parish
B. I am a member of the Church of England (or a Church in communion with the Church of England) and, not being resident in the parish, I have habitually attended* public worship in the parish during the period of six months prior to enrolment
C. I am a member in good standing of a Church (not in communion with the Church of England) which subscribes to the doctrine of the Holy Trinity and also declare myself to be a member of the Church of England and I have habitually attended* public worship in the parish during the period of six months prior to enrolment.
* or would have attended but was prevented from doing so because: :
I declare that the above answers are true and I apply for inclusion on the church electoral roll of the parish. (Please type yes in the box)::*
Please enter the verification number:*
nine four six two two
* Required Fields

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