Application for enrolment on the Church Electoral Roll of the Ecclesiastical Parish of South Bersted

Name:

Address:

Telephone:

Email:

I declare that I am baptised and aged 16 or over  

Or will become 16 in the next 6 months on 

Please tick a or b

a. I believe the Christian faith revealed in the Bible, set forth in the creeds and teaching of the Church of England and apply to be a member of South Bersted Church. I am resident in the parish of South Bersted 

b. I believe the Christian faith revealed in the Bible, set forth in the creeds and teaching of the Church of England and apply to be a member of South Bersted Church. I am not resident in the parish of South Bersted but have regularly attended public worship in the parish during the period of six months prior to enrolment 

OR

I am not resident in the parish of South Bersted but would have regularly attended public worship in the parish during the period of six months prior to enrolment but was prevented by illness or absence or other essential reason from attending. 

If the latter applies, please state the reason for your absence 

I confirm that these details are correct and I apply to join the Electoral Roll of  South Bersted Church 

Date