The Antient Fraternity of Free and Accepted Masons of England
THE PROVINCIAL GRAND LODGE and
ROYAL ARCH CHAPTER OF DURHAM 8 The Esplanade, Sunderland, SR2 7BH, Tel. 0191 567 5365 Email: enquiries@durhamfreemasons.org Website: www.durhamfreemasons.org
PRIVATE & CONFIDENTIAL LODGE NAME: __________________________________________
NUMBER: __________
WIDOWED PARTNER’S DETAILS Full Name Title
Date of Birth
Address Postcode Email address
Phone no.
Deceased Partner’s Name
Mother Lodge, if appropriate
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Email
Emergency Contact Phone no.
CARING VOLUNTEER’S DETAILS Name (in print)
Contact details
To be completed by the Widowed Partner I would like to receive free copies of the Better Lives magazine and other Masonic communications.
YES/NO
I give my consent for my personal details to be held in accordance with the Data Protection Act 2018 by the Provincial Grand Almoner and for use by the Caring Volunteer with respect to the work he does, the details of which have been explained to me. I understand that my details can be deleted if I request it, by writing to the Provincial Grand Almoner at Provincial Grand Lodge of Durham, 8 The Esplanade, SUNDERLAND SR2 7BH or by email at almoner@durhamfreemasons.org Signature of Widowed Partner
Date Version 4 (January 2021)