<p> 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: </p><p>1.</p><p>2.</p><p>3.</p><p>4.</p><p>5.</p><p>6.</p><p>7.</p><p>8.</p><p>9.</p><p>10.</p><p>11.</p><p>12.</p><p>13.</p><p>14.</p><p>15.</p><p>16.</p><p>17.</p><p>18.</p><p>19.</p><p>20.</p><p>Connection Region Conference District Local Church Total Membership Type Code Number of (Connection Amount Sent to CLC Members + Region) </p><p>$ 5.00 $ 10.00 Sustaining Life </p><p>EXPIRATION DATE: Month & Year Name(s) of Deceased Life Member(s)</p><p>LOCAL CONTACT INFORMATION Email address: Telephone # </p><p>*Please Complete Local Contact Information</p><p>Email Electronic Form To: [email protected] Instructions</p><p>Mail CLC Form and Membership Dues to: Connectional Lay Council P.O. Box 26770 Charlotte, NC 28221-6770 Attn: MEMBERSHIPS</p><p> Retain copy of membership form and Local Church portion of membership dues.</p><p> Send copy of membership form and District portion of dues to District Second Vice President.</p><p> Send copy of membership form and Conference portion of dues to Conference Second Vice President.</p><p>Note: Regional Director portion of dues are included in amount sent to CLC office.</p>