Guild of Benevolence Life Membership

Title *

First Name *

Last Name *

Email Address *

Date of Birth (dd/mm/yyyy) * +

Phone Number *

Contact Address

Street 1 *

Street 2

Street 3

City *

County

Postal Code

Country *

Declaration

I hereby confirm that the statements made in this application are, to the best of my knowledge and belief, correct.
The Guild of Benevolence is committed to protecting and respecting your privacy. In accordance with the EU General Data Protection Regulation, the personal data collected in this form will be processed securely in order to provide you with the service(s) requested.

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I agree to the above statements