THE FELLOWSHIP OF CONCERNED CHURCHMEN
*** MEMBERSHIP FORM ***

I/we would like to:
 [___] become a new member of the FCC
 [___] renew an existing membership in the FCC

(Please check the appropriate boxes. Memberships are annual.)

Annual Dues:	[___] Individual ($20), [___] Parish/Church ($20), [___] Family ($25)

NAME(S):	_____________________________________________________________
		_____________________________________________________________
ADDRESS:	_____________________________________________________________
		_____________________________________________________________
PHONE:		_____________________________________________________________
E-MAIL:		_____________________________________________________________
Parish Name	_____________________________________________________________
  & Location:	_____________________________________________________________
Jurisdiction:	_____________________________________________________________

Additional Info for Parishes/Churches Required for Listing in our Directory of Parishes:

Mailing Address (if different from your parish’s physical address or place of meeting):
		_____________________________________________________________
		_____________________________________________________________
Website:	_____________________________________________________________
Clergy:		_____________________________________________________________
		_____________________________________________________________
Sunday Services (please indicate times and types of service):
		_____________________________________________________________
		_____________________________________________________________
Nearest large city and/or metro area:
		_____________________________________________________________

[___]	I am/we are communicants(s) in good standing within the Anglican or Episcopal jurisdiction.
[___]	I am not an Anglican/Episcopal communicant, and apply for Associate Membership.

“I/we agree with the purposes and goals of the Fellowship of Concerned Churchmen and the 
Affirmation of St. Louis.  I/we pledge to work and pray for unity and harmony among orthodox Anglicans.”

Signature(s):	_____________________________________________________________
		_____________________________________________________________

Thank you for your support.  Please make all checks payable in US dollars to "The Fellowship of
Concerned Churchmen" and mail to:

Fellowship of Concerned Churchmen
192 Wellesley Drive, Spartanburg, SC 29307