2017 Society of the Holy Trinity Dues
Please pay dues by June 11 – the Feast of the Holy Trinity
Name: Address for mailing:
Preferred phone: E-mail:
Church body: ÿ ELCA ÿNALC ÿLCMS ÿELCIC ÿLCMC ÿ Other __________________________________________
Has your ministry site or denominational affiliation changed (e.g. you retired or accepted a new call)? Yes ÿ No ÿ
If yes, please describe the change____________________________________________________________________________
Of what chapter are you a member? ___________________________________________________ At Large, check here ÿ
Enclosed check for $300.00 Check number________ OR Paid $309.00 online through PayPal ÿ Date paid ________
Additional offering to the Society of the Holy Trinity enclosed $________ OR given online $________
$______ = TOTAL ENCLOSED or TOTAL PAID
ÿ If your congregation/ministry is sending the check, is your name indicated on or with it?
ÿ Check here if you request a waiver for part of your dues. Please request permission from your Dean if you are a member
in chapter or the Senior if you are a member at large.
Make checks payable to “Society of the Holy Trinity” and send with this sheet to
The Rev'd Pari R. Bailey PO Box 116, Belview, MN 56214
If paying online, form can be emailed to