PLEASE USE BLOCK CAPITALS

I  (full name)   ___________________________________________

Date of Birth  __________________________

Address  ________________________________________________

            __________________________  Post Code  _____________

of     ____________________________________________   Church

in the city/town of     ____________________________

in the Diocese of       _____________________________________

desire to be enrolled as a    * FULL MEMBER      * Priest Associate

                                                    (*delete as appropriate)

of the Guild.  I promise that I shall follow the Rule so long as I shall remain a member of the Guild, the Lord being my helper.

I enclose GBP 5.00 towards the cost of the Medal and Manual.

Witnessed and approved :

___________________________________   Rector/Priest-in-Charge

Proposed date of admission  __________________________

Signed  __________________________________________