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Form 1

Certificate of Lay Deputies to the SYNOD of the Diocese of Quincy

Deputy Name *

Deputy Address

Deputy Telephone

Deputy Email *

Alternate Lay Deputies:

Alternate Deputy Name *

Alternate Deputy Address

Alternate Deputy Tel #

Alternate Deputy Email *

Alternate Deputy Name (copy) *

Alternate Deputy Address (copy)

Alternate Deputy Tel # (copy)

Alternate Deputy Email (copy) *

Alternate Deputy Name (copy) (copy) *

Alternate Deputy Address (copy) (copy)

Alternate Deputy Tel # (copy) (copy)

Alternate Deputy Email (copy) (copy) *

Alternate Deputy Name *

Alternate Deputy Address

Alternate Deputy Tel #

Alternate Deputy Email *

Alternate Deputy Name (copy) *

Alternate Deputy Address (copy)

Alternate Deputy Tel # (copy)

Alternate Deputy Email (copy) *

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