APPLICATION FOR ENROLMENT ON THE CHURCH ELECTORAL ROLL OF THE PARISH OF ST MARY, BITTON, SOUTH GLOUCESTERSHIRE (FORM A)

Full Name

First

Middle

Last

Preferred title if any

Address

Postcode

Email (optional)

Tick only those boxes that apply to you

DECLARATION 1

Please declare the following:

Declaration 1

I am baptised, am a lay person and am aged 16 or over (or will reach the age of 16 within the next 12 months)

Give your date of birth if under 16

Check ONE only of the boxes under 2A OR 2B OR 2C that applies to you

Declaration 2A

I am a member of the Church of England or of a Church in communion with the Church of England and am resident in the parish.

Declaration 2B

I am a member of the Church of England or of a Church in communion with the Church of England, am not resident in the parish, but have habitually attended public worship in the parish during the preceding six months; OR
I am a member of the Church of England or of a Church in communion with the Church of England, am not resident in the parish and would have habitually attended public worship in the parish during the preceding six months but was prevented from doing so because:

Reason

Write in the reason why you were prevented from regularly attending for worship in the preceding six months

Declaration 2C

I am a member in good standing of a Church which is not in communion with the Church of England but subscribes to the doctrine of the Holy Trinity, am also a member of the Church of England and have habitually attended public worship in the parish during the preceding six months; OR
I am a member of the Church of England or of a Church in communion with the Church of England, am not resident in the parish and would have habitually attended public worship in the parish during the preceding six months but was prevented from doing so because:

your Submission birth

Reason

Write in the reason why you were prevented from regularly attending for worship in the preceding six months

Submission

I declare that the above answers are true, and I apply for inclusion on the Church Electoral Roll of the parish. I have read and am content with the guidance notes in respect of the use and management of my personal data and email address (if given).

Please help us improve our communications with you by also completing Form B.