THE ORDER OF THE SECRET MONITOR

OR BROTHERHOOD OF DAVID & JONATHAN

PROVINCE of  WEST YORKSHIRE

 

CESSATION OF MEMBERSHIP

& CHANGE OF DETAILS NOTIFICATION

 

 

CONCLAVE NAME………………………………..No………………

 

To the  Provincial Grand Secretary, please note:-

 

 

Surname………………………… Forename(s)……………………………

 

DIED / RESIGNED  /  WAS EXCLUDED  /  MADE HONORARY MEMBER

(Please delete non– applicable)

 

ON ………………………………..

 

In the case of resignation, please give reason, in the case of exclusion state; Rule No 85 or Rule 119.

 

…………………………………………………………………………………………………

 

…………………………………………………………………………………………………

 

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CHANGE OF DETAILS:

 

ADDRESS……………………………………………………………………………..

 

…………………………………………………………………………………………

 

…………………………………………………………………………………………

 

POSTCODE………………………………………...

 

TELEPHONE………………………………………

 

EMAIL (if any)……………………………………..

 

Please return to Provincial Grand Secretary  as soon as possible after the change in membership or details. (Please do not wait until the Annual Returns.)

 

 

SIGNED…………………………………………….     Conclave Secretary.