Albany Via Media
Episcopalians striving for a middle way
of diversity and tolerance in the Diocese of Albany
Individual Affiliation

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If you think it is more than a year since you last affiliated with  AVM, please renew your affiliation below. If you have not affiliated with Albany Via Media before and would like to, please do so here.       Please check one:  __ New    __ Renewal

Name: ___________________________________________________________

Address: _________________________________________________________

City/State/Zip: ____________________________________________________

Email: ___________________________________________________________

Home Phone: _____________________________________________________

Business Phone: ___________________________________________________

ٱYes, I would like to make a contribution to the work of Albany Via Media

_____ $25 ______ $50 ______ $100 ______ other

Please enclose a check made out to "Albany Via Media, Inc.". Donations are tax deductible.

Please list what kind of work you do, experience, expertise, hobbies, interests, etc

Work Employment: ____________________________________________________________

Experience/Expertise: _________________________________________________________

Hobbies/Special interests: ______________________________________________________

Parish Positions, etc.: __________________________________________________________

Volunteer Work: _____________________________________________________________

I would like to contribute to the work of Albany Via Media in the following way(s)

Committees: prayer ________; legal ________; publicity______; fellowship/liturgy _______; finance_________; education/theology __________; other __________________________

Please send this form to: Treasurer, Albany Via Media, 33 Hubbell Lane, Lake George, New York 12845