Mail CLC Form & Dues To: Effie B. Woodard Connectional Lay Council Second Vice President PO Box 26770 Membership Chairperson Charlotte, NC 28221-6770 919.258.6868 CONNECTIONAL LAY COUNCIL 704.599.4630 Ext. 2566 MEMBERSHIP FORM Episcopal District Conference: P. E. District: Local Church: Pastor: Local President:

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Connection Region Conference District Local Church Total Membership Type Code Number of (Connection Amount Sent to CLC Members + Region)

$ 5.00 $ 10.00 Sustaining Life

EXPIRATION DATE: Month & Year Name(s) of Deceased Life Member(s)

LOCAL CONTACT INFORMATION Email address: Telephone #

*Please Complete Local Contact Information

Email Electronic Form To: [email protected] Instructions

Mail CLC Form and Membership Dues to: Connectional Lay Council P.O. Box 26770 Charlotte, NC 28221-6770 Attn: MEMBERSHIPS

 Retain copy of membership form and Local Church portion of membership dues.

 Send copy of membership form and District portion of dues to District Second Vice President.

 Send copy of membership form and Conference portion of dues to Conference Second Vice President.

Note: Regional Director portion of dues are included in amount sent to CLC office.