Electoral Roll Form

Application for Enrolment on the Church Electoral (Membership) Roll of the

Parish of St Marylebone with Holy Trinity St Marylebone

Full name*

Adress Line 1*

Address Line 2

Post code*

Telephone Number*

Email Address*

I declare that:*

1A I am baptised/christened, aged 16 or over1B I am not baptised/christened, am over the age of 16, and attend worship regularly at St Marylebone Parish Church.2A I am a member of the Church of England (or of a Church in communion with the Church of England) and live in the parish.2B I am a member of the Church of England (or of a Church in communion with the Church of England) and, whilst I do not live in the parish, I have attended public worship in the parish church regularly for at least six months prior to today.2C 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 declare myself to be a member of the Church of England and I have attended public worship in the parish church regularly for at least six months prior to today. I declare that the above answers are true, and I apply for inclusion on the Church Electoral (Membership) Roll of the parish.

or I become 16 on*

Signed*

Date*

To comply with GDPR (Privacy Legislation)

Please confirm your consent to one or more of the following*:

Communications

Yes please, I would like to receive communications by email.Yes please, I would like to receive communications by telephone.Yes please, I would like to receive communications by mobile phone including text message.Yes please, I would like to receive communications by social media.Yes please, I would like to receive communications by post

Newsletters and other Communications

We may contact you to keep you informed about what is happening at St Marylebone Parish Church, of which the Healing and Counselling Center is a part, including news, events, meetings, clubs, groups, and activities. This will usually happen via Portico, our weekly e-newsletter. These communications may also sometimes appear on our website, the Diocesan website or in printed or electronic form including social media

Activities and Groups

We may contact you about groups and activities in which you may be interested in participating. Occasionally names and photos may appear in newsletters, bulletins or on websites, or social media.

Signed

Date

* You can grant consent to any or all the purposes for which we can contact you, and to any, all or none of the methods of communication. Where you do not grant consent, we may not be able to use your personal data (name, address, email, phone number), for example we shall not be able to send you newsletters or inform you of forthcoming services and events. To find out how we use your data, our “Privacy Notice” is available from our website www.stmarylebone.org