Contact List Consent Form for Concord Monthly Meeting of Friends (Quakers)

Concord Friends Meeting has agreed the following Data Protection Policy for its Contact List (informally referred to as ‘The Blue List’).

“This list may be used by members and attenders of Concord Friends Meeting for the administration of the affairs of Concord Friends Meeting and of any bodies set up by Concord Friends Meeting, or for the legitimate purpose of the Religious Society of Friends in New England. It may not be used for other purposes. Everyone on the list has agreed to the inclusion of their name and details, either by becoming a member of Concord Friends Meeting or, if not a member, in writing.

“Please keep copies of this list somewhere safe. Copies of this list should not be left out in the Meeting House.”

Name :

Home phone :

Work phone :

Cell phone :

Address (Line 1) :

Address (Line 2) :

Address (Line 3) : City : State : Zip :

E-mail : Skype Name :

Birthday (Month/Day) :

Preferred Website User Name (e.g., FirstnameLastname) :

Preferred Initial Website Password (use A..Z a..z 0..9 !#$%*+|<>) :

[For tips on creating secure, memorable passwords, see http://wolfram.org/writing/howto/password.html [1] and http://en.wikipedia.org/wiki/Leet#Orthography [2]. For example, the well-known pangram “The quick brown fox jumps over the lazy dog” might be transformed into the more cryptic “Tqbfj0+lcl” or the palindrome “Go hang a salami; I’m a lasagna hog” →“G#4sI4l#”. NB It would probably be best not to use these particular examples.]

I consent to the inclusion of my name and details in the Contact List of Concord Friends Meeting.

Signed: Date:

I consent to the inclusion of the name and details of my children (under the age of 18) in the
Contact List of Concord Friends Meeting.

Signed: Date:

Please return a signed and dated copy of this consent form to the maintainer of the Contact List.

You may withdraw your consent at any time by sending a request, in writing, to the maintainer of the Contact List.

Consent Form as PDF file [3] [4]