The Middlesex County Association &

London Diocesan Guild of Church Bell Ringers

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MEMBER'S DETAILS AND CONSENT FORM

Please read the Declaration Of Consent below before completing the following information. The completed and signed form should be returned to the District Secretary; the Joining Fee should be included for new members.

The District Secretary should provide a copy of the completed form to the Association Membership Secretary.

Title: ____ Name: _______________________________________________________________________________

Membership Type: Ordinary/Ordinary Life/Associate/ Honorary Life (delete as applicable)

Name as you would like it to appear on your certificate of membership:

_______________________________________________________________________________________________

Address: _______________________________________________________________________________________

_________________________________________________________ Post Code: ____________________

'Phone - home: ______________________ - work: ______________________ - other: _________________________

e-mail: __________________________________________________________________________________________

Home Tower: ________________________________________________ District: ___________________________

Election Details

Date Elected (if known):___________________________ Meeting at which elected:___________________________

Proposed by: ____________________________________ Seconded by: ____________________________________

DECLARATION OF CONSENT UNDER THE DATA PROTECTION ACT 1998

Please note that the details which you have provided on this form will be held on a computer and may also be held in a manual filing system. This data will be processed by The Middlesex County Association and London Diocesan Guild of Church Bell Ringers ('The Association') and may be included in The Association's annual report.

Where you are a tower correspondent or an officer of The Association, it may also be published on The Association’s web pages and/or newsletters and provided to third parties such as the Central Council of Church Bell Ringers (who may publish it on the CCCBR web site), The Ringing World Limited (for publication in the Ringing World, the Ringing World website and/or the Ringing World Diary), and to other ringers upon request. The data may also be sent to ringers or bellringing associations outside the European Economic Area (i.e. the fifteen EU Member States together with Iceland, Liechtenstein and Norway) upon request.

Details of peals rung on behalf of The Association, including names of the ringers, will be sent to the Ringing World and to The Association's Peal Secretary for publication.

If you wish to obtain a copy of the data processed, a description of the purposes for which it is being processed, description of any potential recipients of the data, or any information as to the source of the data, please contact The Association's Membership Secretary (as listed in the annual report of The Association). Please note that The Association is entitled to charge a statutory fee not exceeding £2 (two pounds) for the provision of this information.

Please sign below to confirm your consent to your personal data being processed in the manner set out above and as necessary for the purposes of the legitimate interests of The Association.

Signed (Member):

Date:

(Note: A Member may be happy for certain data to be published but not other data. Any such restrictions to the consent should be specified by the Member at the time of signing.)