The Union of Black Episcopalians National Board of Directors APPLICATION FOR NATIONAL Honorary Board Chair MEMBERSHIP OR RENEWAL The Rt. Rev. Carl W. Wright President The Very Rev. Kim L. Coleman Name First Vice President Address The Rev. Guy Leemhuis, Deacon City Second Vice President Mrs. Ayesha Mutope-Johnson State Zip Secretary Phone ( _____ ) The Rev. Linda Tardy Wilson, Deacon, Retired Fax ( _____ ) Treasurer E-Mail The Rev. Clive Oscar Sang, Deacon Regional Directors Parish Mr. Michael Hughes, Northeast Diocese Ms. Carrie A. Brown, Mid-Atlantic Chapter Aliation Ms. Alma Flowers, Southeast Ms. Roxanne Chargois, Southwest The Rev. Ellis Clifton, Jr, Midwest The Rev. Dr. Mauricio J. Wilson, Western At-Large Type of Membership, includes local (Please check one) Individual $100 Members Family $175 The Rev. Dee Wellington Bright Retired $80 The Rev. Sheldon Hamblin Youth - under 21 $50 The Rev. Nathanaël Saint-Pierre The Rev. Canon Benjamin Musoke-Lubega Youth Nat'l. Life Memberships (Payable in 5 yearly installments) Advisor Platinum $2000 Ms. Imani Jackson Gold $1000 Youth Representatives Silver $750 Miss Olivia Bolden Bronze $500 Mr. Andrew Bolden Sponsors (payable annually) Young Adult Representative Church $150 Mr. Darius March’e Jenkins-Hudgins Organizations $150 Youth Chaplain Associate $50 The Rev. Edwin Johnson Email
[email protected] to make an electronic Immediate Past President payment . (Preferred) Canon Annette L. Buchanan MasterCard Visa American Express Card# The Pacific Northwest Chapter of The Union of Black Episcopalians - Expiration Date The Dioceses of Olympia and Oregon Signature email:
[email protected] Phone: 503-593-8672 Make checks payable to: pnwube.org (under dev.) The PNW Chapter of The UBE facebook.com/pnwube PO Box 96001 Portland, OR 97296 Daniel W.