Union of Black Episcopalians
Facebook-f
Twitter
Youtube
Menu
About Us
Mission & Vision
Regions & Chapters
MID-ATLANTIC
MID-WESTERN
NORTHEAST
SOUTHEAST
SOUTHWEST
WESTERN
Resources & Forms
Membership Roster
Chapter Treasurer Report
Receipts & Disbursements
Necrology Form
Report New Chapter
(UBE) Chapter Affiliation Agreement
Proposed Bylaws Modification Form
2024 Bylaws
2025 Bylaws
Media Gallery
UBE Store
Facebook-f
Twitter
Youtube
donate
Membership Roster
Membership
Address
Email
Phone
Parish
Diocese
Individual
Family
Senior
Youth
Life
Church
Chapter Treasurer
Chapter Website
Submit
Name of Chapter:
Reporter Signature
Number of Membership Applications Submitted:
Date:
Information
Last Name
First Name
MI
Address
City
ST
Zip
Phone (H)
(O)
(Cellular/Other)
Email (Work)
Email (Home)
Parish
Membership Type
Amount Collected $
Paid National $
Paid Chapter Dues $
Information
Last Name
First Name
MI
Address
City
ST
Zip
Phone (H)
(O)
(Cellular/Other)
Email (Work)
Email (Home)
Parish
Membership Type
Amount Collected $
Paid National $
Paid Chapter Dues $
Information
Last Name
First Name
MI
Address
City
ST
Zip
Phone (H)
(O)
(Cellular/Other)
Email (Work)
Email (Home)
Parish
Membership Type
Amount Collected $
Paid National $
Paid Chapter Dues $
Name of Chapter:
Reporter Signature
Total Number of Members Reported:
Total Number of Youth Members Reported:
Total Number of New Members Reported:
Total $ Collected for individual membership:
Total $ Collected for family membership:
Total $ collected for retired membership:
Total $ collected for youth (under 21):
Total $ collected for life membership :
Total $ collected for sponsor (church):
Total $ collected for sponsor (organization):
Total $ collected for sponsor (associate):
Chapter yearly assessment
Totals collected for National:
Totals collected for Chapter:
Grand Total:
Submit
