2018 CONGREGATION DATA FORM	
Church Name:	     	Church City:	     	Office Phone:	     	
Complete Mailing Address:	     	
Office Fax:	     	Office Secretary’s Name:	     	
Please complete (type is preferred, but if not available please print in ink) for your newly elected 2018 Vestry and
Convention Delegates and Alternates, and no later than March 1, 2018, return to:
Diocese of Eastern Michigan
924 N. Niagara, Saginaw, MI  48602	
				
1.Clergy:	     	2. Asst. Clergy or Administrator:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Home Phone 	     	Home Phone	     	
Fax	     	Fax	     	
Email	     	Email	     	
				
3. Sr Warden Name:	     	4. Jr. Warden Name:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Telephone (home)	     	Telephone (home)	     	
Telephone (work)	     	Telephone (work)	     	
Fax	     	Fax	     	
Email	     	Email	     	
Rotates off what year?	     	Rotates off what year?	     	
				
5. Clerk Name:	     	6. Treasurer Name:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Telephone (home)	     	Telephone (home)	     	
Telephone (work)	     	Telephone (work)	     	
Fax	     	Fax 	     	
Email	     	Email	     	
Rotates off what year?	     	Rotates off what year?	     	
				
Give correct mailing addresses for Delegates and Alternates to Convention:	
				
1. Delegate Name:	     	2. Delegate Name:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Telephone/Email	     	Telephone/Email	     	
				
3. Delegate Name:	     	4. Delegate Name:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Telephone/Email	     	Telephone/Email	     	
				
1. Alternate Name:	     	2. Alternate Name:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Telephone/Email	     	Telephone/Email	     	
				
3. Alternate Name:	     	4. Alternate Name:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Telephone/Email	     	Phone/Email                       	      	

			Please continue on back side	

Please complete for ALL non-officer Vestry members:		
				
Vestry Name:	     	Vestry Name:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Telephone (home)	     	Telephone (home)	     	
Telephone (work)	     	Telephone (work)	     	
Fax                                                                 	      	Fax                                                                 	     	
Email	     	Email	     	
Rotates off what year?	     	Rotates off what year?	     	
				
Vestry Name:	     	Vestry Name:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Telephone (home)	     	Telephone (home)	     	
Telephone (work)	     	Telephone (work)	     	
Fax                                                                	     	Fax                                                                	     	
Email	     	Email	     	
Rotates off what year?   	     	Rotates off what year?   	     	
				
Vestry Name:	     	Vestry Name:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Telephone (home)	     	Telephone (home)	     	
Telephone (work)	     	Telephone (work)	     	
Fax                                                                 	     	Fax                                                                 	     	
Email	     	Email	     	
Rotates off what year?	     	Rotates off what year?	     	
				
Vestry Name:	     	Vestry Name:	     	
Address:	     	Address:	     	
City/State/Zip	     	City/State/Zip	     	
Telephone (home)	     	Telephone (home)	     	
Telephone (work)	     	Telephone (work)	     	
Fax                                                                 	     	Fax                                                                 	     	
Email	     	Email	     	
Rotates off what year?	     	Rotates off what year?	     	
				
Vestry Name:	     	Please attach paper with additional vestry member and clergy information if necessary.   	
Address:	     			
City/State/Zip	     			
Telephone (home)	     	Total # of vestry members:	     		
Telephone (work)	     			
Fax                                                                	     			
Email	     			
Rotates off what year?   	     			
				
Vestry Name:	     			
Address:	     			
City/State/Zip	     			
Telephone (home)	     			
Telephone (work)	     	Signature of Sr or Jr Warden: 	     	
Fax                                                                	     	
Email	     		
Rotates off what year?   	     		
		Please mail to diocese by March 1, 2018