Appendix 1: Sample Membership Record

The following form may be used for keeping the membership records of a monthly meeting. This form is intended only as a sample; meetings should feel free to alter it or design their own forms, according to their needs.

Some meetings may not recognize all the categories of membership mentioned on the form, such as birthright membership and associate membership.

Some information included on the form, such as data about members’ families, may be useful but not strictly necessary for meetings to record. Meetings are urged to consider carefully what information to gather, and how much of this information they will regard as optional.

Meetings may receive requests for information in their records, from individuals researching their family histories or for other reasons. Clear policies should be adopted about when such information may be shared. These policies should be made clear to new members as they provide their data for the records.

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Membership Record

Record number: ______ Record closed □

Name: _____________________________________

Previous name(s):______________________________

Contact Information

Address: ____________________________________

____________________________________

Telephone number(s):___________________________

E-mail address(es):_____________________________

Admission Data

Date of Admission: ____________

□ by birth or adoption

□ by application

□ by transfer from ______________

Membership Type: □ full

□ associate, expires on ___________

Termination Data

Date of Termination: __________

□ by death

□ by release

□ by transfer to ________________

Remarks:

Personal and Family Data

Birthdate: _____________

Place of birth: _____________________________

Father’s Name: _____________________________

Birthdate: __________ Location: ______________

Is/was a member? □

Mother’s Name: ____________________________

Birthdate: __________ Location: ______________

Is/was a member? □

Marriage 1 to: ______________________________

Date: ______________ Location: ______________

Is/was a member? □

Marriage 2 to: ______________________________

Date: ______________ Location: ______________

Is/was a member? □

Marriage 3 to: ______________________________

Date: ______________ Location: ______________

Is/was a member? □

Child/Stepchild 1 : ___________________________

Date: ______________ Location: ______________

Is/was a member? □

Child/Stepchild 2 : ___________________________

Date: ______________ Location: ______________

Is/was a member? □

Child/Stepchild 3 : ___________________________

Date: ______________ Location: ______________

Is/was a member? □

Child/Stepchild 4 : ___________________________

Date: ______________ Location: ______________

Is/was a member? □

Child/Stepchild 5 : ___________________________

Date: ______________ Location: ______________

Is/was a member? □

Series Navigation

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