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Certificate of Convention Delegates (2021, 153rd Convention)

This certification may be completed by the Rector, Warden, or Clerk of the Vestry. 

Please consult the "Delegates Allowed by Parish 2021" sheet to ensure you add the right number of Lay Delegates (or Lay Representatives, for Chapels), Alternate Lay Delegates (Alternate Lay Representatives, for Chapels), and Youth Delegates. 

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A copy of your Certification of Lay Delegates will be send to this address for your records.

If your parish is in arrears, you may still complete this form to certify your Convention Delegates. Your Delegates may attend Convention but will not have voice or vote. Voice and vote are restored to parishes no longer in arrears. 

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(mm/dd/yyyy)
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Prefix
First Name
Last Name
Suffix
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Lay Delegates
For PARISHES only (Chapels, please complete "Lay Representative" below)

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Lay Representative
For CHAPELS only

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Alternate Lay Delegates
For PARISHES only (Chapels, please complete "Alternate Lay Representative" below)

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Alternate Lay Representative
For CHAPELS only

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Youth Delegates

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Prefix
First Name
Last Name
Suffix


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country