Please print out and return this form to The Membership Secretary, The Milner Wing, The Shrine of Our Lady of Walsingham Common Place, Walsingham, Norfolk NR22 6BP
We, being members of the Society of the Holy House of Our Lady of Walsingham, together with the duly nominated first Superior named below, request the setting-up of a Cell of the Society, to be named:
| The Cell of the Society of the Holy House of Our Lady of Walsingham and Saint(s): | |
|---|---|
| (Please enter chosen name(s)) | |
| The Cell will be based at the Church of(please give dedication) | |
| Or the School of | |
| In the Diocese of | |
| We nominate as the first superior (Priest Associate of the Holy House) |
|
| Where the person nominated is not the incumbent or head of the institution named above: | |
| With the permission of: | |
| Name and Office | Signature |
| We appoint a Cell Secretary: | |
|---|---|
| Name | Telephone |
| Address | Email: |
| Names (in BLOCK CAPITALS) and signatures of 7 Founder Members: | |
|---|---|
| Name | Signature |
| Name | Signature |
| Name | Signature |
| Name | Signature |
| Name | Signature |
| Name | Signature |
| Name | Signature |
| Signature: Nominated First Superior | |