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: _____________________________________ BROTHER’S DETAILS
NUMBER: __________ PARTNER’S DETAILS
Full Name
Full Name
Date of Birth
Date of Birth
Address
Address (if different)
Postcode
Postcode
Telephone no
Telephone no
Mobile no
Mobile no
Occupation Date of marriage or civil partnership (if applicable)
DEPENDANTS DETAILS
Date of Initiation
Names
DOB
Date joined the Lodge Mother Lodge Membership of other Lodges
We, being the Brother and, if applicable, partner, referred to above, consent to the above data being held in accordance with the Data Protection Act 2018 by the Lodge Secretary and for use by the Lodge Almoner in accordance with the purposes that 1/we confirm have been given to us. Signature of Brother
Date
Signature of Partner
Date
Version 1 (April 2020)