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): *