Diocesan Synod - 2024 Certificate of Election

First Lay Delegate
(1) Lay Delegate Name

First NameLast Name
(1) Lay Delegate Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(1) Lay Delegate Email
example@example.com
(1) Lay Delegate Phone Number
Please enter a valid phone number.
(1) Did this lay delegate attend the last two consecutive Diocesan Synods?

YesNo

Second Lay Delegate
(2) Lay Delegate Name

First NameLast Name
(2) Lay Delegate Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(2) Lay Delegate Email
example@example.com
(2) Lay Delegate Phone Number
Please enter a valid phone number.
(2) Did this lay delegate attend the last two consecutive Diocesan Synods?

YesNo

Alternates

Section 5(5): Each Parish may elect or appoint an alternate for each lay representative or your delegated elected or appointed.

An alternate may register to attend Synod only if he or she is replacing a named delegate who is no longer able to attend. The alternate must first obtain written notice from the Rector, Priest-in-Charge or Incumbent. Once registered, the alternate becomes the Parish delegate and a Member of Diocesan Synod until the next regular session of Diocesan Synod.
First Alternate Delegate
(1) Alternate Lay Delegate Name

First NameLast Name
(1) Alternate Lay Delegate Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(1) Alternate Lay Delegate Email
example@example.com
(1) Alternate Lay Delegate Phone Number
Please enter a valid phone number.
(1) Did this alternative lay delegate attend the last two consecutive Diocesan Synods?

YesNo

Second Alternate Delegate
(2) Alternate Lay Delegate Name

First NameLast Name
(2) Alternate Lay Delegate Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(2) Alternate Lay Delegate Email
example@example.com
(2) Alternate Lay Delegate Phone Number
Please enter a valid phone number.
(2) Did this alternative lay delegate attend the last two consecutive Diocesan Synods?

YesNo

Alternate Youth Delegate
Alternate Youth Delegate Name

First NameLast Name
Alternate Youth Delegate Date of Birth

MonthDayYear
Date
Alternate Youth Delegate Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Alternate Youth Delegate Email
example@example.com
Alternate Youth Delegate Phone Number
Please enter a valid phone number.
Did this alternative youth delegate attend the last two consecutive Diocesan Synods?

YesNo

Clergy Members of Diocesan Synod

Section 4(2): Members of the clergy ordinarly resident in the Diocese who hold a license from the Bishop and are not under any charge or inhibited, suspended or deprived and who are employed in or appointed to a non-parish ministry in the Diocese (for example: Synod staff; faculty or staff of Atlantic School of Theology; hospital, prison, or institutional chaplains); or who are appointed to a parish as rector or incumbent; and not more than one (1) member of the clergy elected or appointed by the Parish from admidst the number appointed a Parish in a capacity other than as rector or incumbent are entitled to be members of Synod.

Section 3(f): At an electoral Synod, all clergy holding a license, and who are not under any charge or inhibited suspended or deprived are eligible for membership.
Rector, Incumbent, Priest-in-Charge

First NameLast Name
Email for Rector, Incumbent, Priest-in-Charge
example@example.com
Cell Phone Number for Rector, Incumbent, Priest-in-Charge
Please enter a valid phone number.
Additional Clergy Member (where applicable) as per Constitution Section 4(2)(iii)

First NameLast Name
Email for Additional Clergy Member
example@example.com
Cell Phone Number for Additional Clergy Member
Please enter a valid phone number.

I, blanks Rector/Incumbent/Priest-in-Charge of the Parish of blank , Parish number blanks,blanks in the Region of blanks , attest that the aforementioned lay persons were duly elected on blanks (date) at the Parish Annual General Meeting (or subsequently at a meeting of Parish Council) to represent this Parish at the 2025 Diocesan Synod in accordance with the Constitution, Section 18(1).

Note: The Rector/Incumbent/Priest-in-Charge must sign this form prior to the delegate registration process.
Signature of Rector/Incumbent/Priest-in-Charge

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Date signed

MonthDayYear
Date
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Lay Representatives to Synod