Episcopalians striving for a middle way of diversity and
tolerance in the Diocese of Albany
Parish Affiliation
Name of Parish: ____________________________________________________
Address: _________________________________________________________
City/State/Zip: ____________________________________________________
Email: ___________________________________________________________
Business Phone: ___________________________________________________
ڤ Yes, Our parish wishes to affiliate with Albany Via Media
ڤ Yes, Our parish plans to pray for the work of Albany Via Media
ڤ Yes, Our parish plans to financially support Albany Via Media
Dollar amount of your pledge: ______________________________________
Please make checks out to "Albany Via Media".
For the Congregation: For Albany Via Media:
_____________________________________ ____________________________________
Rector/Priest-in-Charge
President
_____________________________________
Senior Warden
Please send this form to: Treasurer, Albany Via Media, 33 Hubbell Lane, Lake George, New York 12845