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REGISTRATION BROCHURE
St. Michael the Archangel
Catholic Church, Cary, NC
S ATURDAY
O CTOBER 18, 2014
CELEBRANT
AND HOMILIST
The Most Reverend
Michael F. Burbidge
Bishop of Raleigh
Easy
Online
Registration
www.dioceseofraleigh.org
A day filled with opportunities to deepen your
love of Jesus Christ, grow in your faith, and
learn new ways to provide loving service to
others.
Un día lleno de oportunidades para profundizar
tu amor en Jesucristo, crecer en tu fe y aprender
nuevas formas de brindar un servicio con amor a
los demás .
Registration Deadline
October 10
Early Bird rate ends Sept. 5
Inquiries: [email protected] / 919.645.4447
WORKSHOPS
SESSION A: 10:45-11:55
SESSION B: 12:10-1:20
SESSION C: 1:35-2:45
SESSION D: 2:55-4:05
PARISH SOCIAL MINISTRY AND RESPECT LIFE LEADER MEETING
This track will be held during Sessions A and B with lunch included. Participants will also need to choose workshops for Sessions C and D.
Office of Human Life and Dignity, Diocese of Raleigh:
Ms. Jackie Bonk, Director; Ms. Melissa DuCharme, Social Concerns
and Advocacy Coordinator, and Ms. MaryBeth Phillips, Respect Life
Ministry Coordinator
Come learn more about our newly formed Office of Human Life and Dignity!
Ministry collaboration in our parishes is central to upholding the human dignity
of all people from conception to natural death. This session will provide real and
applicable best practices for parish committees as well as sharing the direction
and activities of the new diocesan office.
Ms. Mishaun Mitchell, MSW, Adoption and Pregnancy Support
Social Worker for Catholic Charities, Diocese of Charlotte
What questions do you have about the adoption process? Find out about both
domestic and international adoptions and what care and support is offered to
young mothers in crisis pregnancies. Also learn about how parishes can be
engaged in supporting adoptive and birth families.
FOR CHILDREN AGES/AÑOS 3-11 ~ PRE-REGISTRATION REQUIRED / SE REQUIERE UNA PRE-INSCRIPCIÓN
$5.00 for each child / El costo por cada niño es $5.00 dólares
Ms. Lettie Banda, Administrative Assistant, Office of Hispanic Ministry, Diocese of Raleigh;
and St. Michael the Archangel Trinity Center Staff
This special track, designed for children ages 3 to 11, will be held at the St. Michael’s Trinity Center and will include lots of fun-filled
activities, outdoor play time and much more. Classes will be organized according to the age of the child (toilet trained a must!).
Parents are welcome to bring children to the Convocation Mass or take them directly to the program after check-in. A pizza lunch is
included or children may bring their own. Kindly register children with parent’s registration.
Este taller especialmente diseñado para niños entre las edades 3 y 11 años, se llevará a cabo en St. Michael’s Trinity Center e incluye muchas
actividades divertidas, de recreo y más. Las clases se organizarán de acuerdo a la edad del niño (debe estar entrenado para ir al baño por si
solo). Los padres son bienvenidos a traer sus niños a la Misa de la Convocación Católica o llevarlos directamente al programa, después de su
inscripción en la mesa de registración. El almuerzo incluye pizza o si desea, puede traer su propio almuerzo. Por favor incluya el nombre del
niño en la hoja de inscripción.
CATEQUESIS Y FAMILIAS MULTICULTURALES
(Workshop Repeated in English #C-1)
A-1
Dr. Hosffman Ospino, Assistant Professor of Theology and Education,
Boston College, Boston, Massachusetts
La familia es el contexto más inmediato en el cual una generación comparte la fe
con la siguiente. ¿Cómo hacen esto las familias católicas en medio de la diversidad
cultural que caracteriza el catolicismo estadounidense en el siglo XXI? En esta
presentación reflexionaremos sobre esta pregunta clave, prestando atención a la
manera como las familias católicas en los Estados Unidos comparten la fe a la luz de
distintas tradiciones culturales. También exploraremos algunas realidades
contemporáneas de nuestra cultura que con frecuencia desafían la vocación de la
familia católica a ser una comunidad evangelizadora auténtica. Pensaremos en
estrategias prácticas para ayudar a las familias católicas a compartir la fe
con entusiasmo.
PARENT MUST BE
A REGISTERED
CONVOCATION
PARTICIPANT
Solamente se
brindará
cuidado de niños,
para los
participantes
entre las edades
de 3 a 11 años
HISTORIAS VIVAS DE LA BIBLIA
C-2
SPONSORED BY ST. MARY’S PRESS
(Workshop Repeated in English #D-2)
Ms. Pam Elsey, Southeastern Sales Consultant, Saint Mary’s Press,
Winona, Minnesota
Esta sesión para catequistas y maestros/as de nivel elemental (K-5) enfatiza la
importancia de incluir actividades dinámicas que ayuden hacer conexión en nuestras
sesiones a fin de enseñar más efectivamente a nuestros niños acerca de la Biblia y
las historias centradas en la Historia de la Salvación. Los participantes tomarán parte
en las diferentes actividades persuasivas y divertidas relacionadas con la Biblia para
que las utilicen y las adapten primordialmente para los niños de grado intermedio y
elemental. También habrá tiempo para que los asistentes compartan sus propias
ideas para que se conecten a las actividades relacionadas con la Biblia.
Prácticas de Pastoral Migratorias y
Multicultural
D-3
Deacon Juan Carlos Campos, St. Elizabeth of Hungary, Raeford
Compartir experiencias y modelos para trabajar en la pastoral migratoria parroquial,
respetando la cultura y tradición de los pueblos.
WORKSHOPS
SESSION A: 10:45-11:55
FAMILY PRAYER FOR FAMILY TIMES - GRADES K, 1 & 2
SESSION B: 12:10-1:20
B-9 or
C-9
Sister William Catherine Brannen, IHM, Preparatory Teacher, Third
Grade, Saints Philip and James, Exton, Pennsylvania
Both parents and catechists are invited to explore the meaning of prayer, its
necessity in our lives, and how to help your child/children encounter God in prayer.
D-2
BIBLE STORIES ALIVE
SPONSORED BY SAINT MARY’S PRESS
Ms. Pam Elsey, Southeastern Sales Consultant, Saint Mary’s Press,
Winona, Minnesota
This session for catechists or teachers of elementary level (K-5) emphasizes the importance
of including engaging activities in our sessions in order to teach our children more
effectively about the Bible and its central stories of salvation history. Participants will take
part in different compelling and fun Bible-related activities that can be used and adapted for
both primary and intermediate elementary children. There will be time for attendees to
share their own ideas for engaging Bible-related activities as well.
PRAYERS AND RITUALS FOR CHILDREN
A-10 or
B-10
SPONSORED BY WILLIAM H. SADLIER, INC.
Kathy Hendricks, National Catechetical Consultant William H. Sadlier,
Inc., New York
Prayer in the Catholic tradition involves a variety of elements, including music,
movement, and a mix of words and silence. In this session, we will look at each of
these elements and how to craft prayer services that involve, intrigue, and engage
children in expressing love, praise, gratitude, and hope for and in God.
MARRIAGE ON A LAMPSTAND: A NEW PARADIGM FOR
CHRISTIAN MARRIAGE
B-11 or
D-11
Mr. Andrew and Mrs. Terri Lyke, Archdiocese of Chicago, Office of
Black Catholic Ministry and the ArusiNetwork, Inc.
This workshop explores how marriage, as a sacrament of the Church, reflects God
and signals a real presence of God to the world. With a stronger emphasis on the
public dimension of marriage (mission), couples find more satisfaction in their
marriages and better serve their families, communities, and broader society.
SESSION C: 1:35-2:45
SESSION D: 2:55-4:05
CATECHESIS AND MULTICULTURAL FAMILIES
C-1
Dr. Hosffman Ospino, Assistant Professor of Theology and Education,
Boston College, Boston, Massachusetts
The most immediate context in which one generation passes on the faith to the
next is the family. How are Catholic families doing so amidst the cultural diversity
that characterizes American Catholicism in the 21st century? Together we will
envision practical strategies to empower Catholic families to pass on the faith with
enthusiasm.
FAMILY PRAYER FOR FAMILY TIMES - GRADES 6, 7 & 8
B-13 or
C-13
Sister Danielle Therese Teti, IHM, Freshman/Sophomore Teacher,
Villa Maria Academy High School, Malvern, Pennsylvania
Both parents and catechists are invited to explore the meaning of prayer, its
necessity in our lives, and how to help your middle school child/children encounter
God in prayer.
BURNOUT AND BEYOND—FOR PARENTS AND MINISTERS A-14
Mr. Doug Tooke, Director of Catholic Formation Services, Diocese of
Helena, Montana
If you have reached that critical point of burnout, discover what you need to do to
recharge and reignite your passion for family and/or ministry.
THE STORY OF TALENTS
C-14
Mr. Doug Tooke, Director of Catholic Formation Services, Diocese of
Helena, Montana
Children are very different but all are rooted in love. This session explores how
both parents and ministers are called to bring forth the gifts of children for the
service of the Lord.
A PARISH RESPONSE TO POVERTY: DEVELOPING A LOCAL A-12 or
CONFERENCE OF THE SOCIETY OF ST. VINCENT DE PAUL D-12
Mr. Bill Migley, Society of St. Vincent de Paul; and Mr. Pat Brown,
Catholic Charities Board Member
Explore with a national and a local leader how you can develop the Society of
St. Vincent de Paul at your parish. Hear how you can serve the poor to create a
community of spiritual growth through this service to others.
WORKSHOPS
SESSION A: 10:45-11:55
SESSION B: 12:10-1:20
PREPARING FOR AND RECOVERING FROM DISASTERS
A-15 or
C-15
Mr. Daniel Altenau, Grants & Quality Assurance Manager, Catholic Charities;
and Ms. Monica Raynor, MSW, LCSW, Catholic Charities, Diocese of Raleigh
This workshop will provide insight into what Catholic Charities is doing to help
parishes and families in the Diocese prior to and following disasters. You will be
introduced to broad ideas of what both parishes and families can do to prepare for
hurricanes, tornadoes, flooding and fires. There will also be an announcement
about a new and exciting project that Catholic Charities is working on with the
American Red Cross that will allow parishes and individuals to assist with disaster
response.
COMMUNICATIONS & THE FAMILY: HOW TO BE AN
EFFECTIVE CATHOLIC COMMUNICATOR
A-16 or
B-16
Mr. Billy Atwell, Director, Communications, Diocese of Raleigh
Participants will come to an understanding of communications in the Catholic Church
as they are guided through the Church’s teachings about communication. All will be
encouraged to allow their personal stories to be tools for evangelization. Parents
attending will be asked to consider how they might frame the issue of communications with their children.
UNDERSTANDING MILITARY FAMILY STRESS AND
OPPORTUNITIES FOR FAITH COMMUNITY SUPPORT
D-17
Reverend William Cantrell, Associate Director of Chaplaincy,
VA Mental Health and Chaplaincy, Durham
This workshop will present common forms of stress experienced in military family
life due to frequent transitions, extraordinary challenges in duty, separation and
other external factors. Participants should have both a better understanding of and
enhanced ability to recognize the dynamics of military life, its effect on families and
how their faith community might offer support.
B-18 or
THE PRECATECHUMENATE: ESSENTIAL ISSUES OFTEN
MISSED IN FORMING COMMITTED DISCIPLES IN THE RCIA D-18
Monsignor Michael Clay, Pastoral Studies Department Chair,
Catholic University of America, Washington, DC
Why do people leave the Church after entering it through the RCIA? Experts suggest
that one reason lies in the way the inquiry period (period of evangelization and
pre-catechumenate) is conducted and what does and doesn't get addressed in this
period. This workshop will explore the critical issues that must be addressed at the
beginning if catechists are to improve the retention rate of adults and children of
catechetical age coming into the Church.
SESSION C: 1:35-2:45
SESSION D: 2:55-4:05
FAMILY PRAYER FOR FAMILY TIMES - GRADES 3, 4 & 5
B-19 or
C-19
Sister Maureen Donati, IHM, Principal, Our Lady of Lourdes Catholic
School, Raleigh
Both parents and catechists are invited to explore the meaning of prayer, its
necessity in our lives, and how to help your primary aged child/children encounter
God in prayer.
PRISON MINISTRY
C-4
Ms. Melissa DuCharme, Social Concerns and Advocacy Coordinator,
Office of Human Life and Dignity, Diocese of Raleigh
Prison Ministry seeks to ensure a pastoral and sacramental presence at North
Carolina correctional facilities in the Diocese of Raleigh and to provide continued
support to offenders re-entering society. Come learn about efforts in the Diocese to
increase Catholic prison ministry. Participants will learn why Catholics are called to
this ministry, what's going on, and how to get involved.
LAY MINISTRY: SERVING GOD, OTHERS, AND THE FAMILY A-20 or
D-20
Panel Members: Mr. Tristan Evans, Parishioner, St. Michael the Archangel, Cary;
Ms. Jayne Gallo, Lay Ecclesial Ministers’ Association Executive Committee;
Ms. Lauren Green, Director, Office of African Ancestry Ministry and
Evangelization, Diocese of Raleigh
Come and hear how parents at different ages can live out their baptismal call as
lay ministers. Learn how serving in lay ministries can enrich family life and how
parishes can make lay ministry “family friendly”.
ADVANCED DIRECTIVES: WHAT YOU NEED TO KNOW
A-7 or
D-7
Mr. Charles N. Griffin, III, Attorney, Parishioner, St. Catherine of
Siena, Wake Forest
Are you aware that the Catholic Diocese of Raleigh, in consultation with experts in
Catholic bioethics and law, has created an Advance Directive Document to be used
as a companion document to “Comfort and Compassion: A Catholic Declaration on
Life and Death”? Come learn more about this document and how you can use it.
HOW THE PARISH PREPARES FOR MASS
C-21
Mr. Gerard Hall, Director, Office of Divine Worship, Diocese of Raleigh
Do you serve on your parish Liturgy Committee, as a music minister, in any other
liturgical ministries? Come and learn how all these ministries can best work
together in order to enhance worship of God in your parish.
WORKSHOPS
SESSION A: 10:45-11:55
CREATING PARISH COMMUNITIES OF SALT AND LIGHT
SESSION B: 12:10-1:20
D-8
Ms. Bev Jolly, Cape Fear Deanery Respect Life Coordinator and Parishioner,
St. Therese, Wrightsville Beach; and Mr. John Tramontin, Immigration Ministry
Leader and Parishioner, St. Michael the Archangel, Cary
We were reminded in Pope Benedict XVI's Deus Caritas Est that love for the widows
and orphans, prisoners, and the sick and needy of every kind, is as essential to the
Church as are the sacraments and preaching of the Gospel. All parish leaders are
encouraged to attend this workshop to learn how two parishes have collaborated to
create successful models for serving the needy.
ADOPTION
D-6
Ms. Mishaun Mitchell, MSW, Adoption and Pregnancy Support
Social Worker for Catholic Charities, Diocese of Charlotte
What questions do you have about the adoption process? Find out about both
domestic and international adoptions and what care and support is offered to young
mothers in crisis pregnancies. Also learn about how parishes can be engaged in
supporting adoptive and birth families.
SESSION C: 1:35-2:45
IMMIGRATION: A CALL TO CATHOLIC CHARITIES AND
PARISHES TO SERVE THE STRANGER
A-23
Monsignor Joseph Kazibwe Ntuwa, Sacramental Minister, UNCW
Catholic Campus Ministry
Life's greatest joys and hurts both come in our relationships with other people.
How does God's grace serve as the essential ingredient in all our relationships?
How can our response to grace limit our hurts and increase the joys we
experience?
SHARE YOUR JOY OF THE GOSPEL
A-24 or
D-24
Dr. Nina Rizzo, Founder, Open Door of Faith, Cary
Joy is contagious. We “catch it” by encountering others who are joyful. Pope
Francis tells us that a personal encounter with Jesus Christ is the source of all
Christian joy. The New Evangelization challenges us to go out and proclaim
Christ's love and mercy. This workshop can help you acquire your own voice to
comfortably and confidently share the joy of your Catholic faith with others.
B-22 or
C-22
Ms. Consuelo Kwee, Catholic Charities, Raleigh; and Ms. Margi Keating,
Parishioner, Justice for Immigrants Ministry, Sacred Heart Cathedral, Raleigh
This workshop will address the basics of immigration laws and how they are
affecting our immigrant community. We will give an overview of why immigrants
see the need to migrate to this country and how Catholic Charities and parishes can
work in collaboration to serve immigrants to our Diocese.
HUMAN TRAFFICKING
C-5
Ms. MaLisa Johnson Umstead, Centre for Redemption, Wilmington
In 2013, North Carolina was ranked as a top-10 state for human trafficking,
which includes both labor and sex trafficking. Come to this session to hear more
about the prevalence of human trafficking right here in NC, learn how we as
Catholics are called to respond, and how parishes and individuals can provide
the pastoral care needed to assist the victims.
YOUNG ADULT PANEL
RESPONDING TO GOD’S GRACE IN OUR RELATIONSHIPS
SESSION D: 2:55-4:05
A-25 or
C-25
Moderator: Mr. Robert Shaw
Panel Members: Reverend Thomas Duggan, Parochial Vicar, St. Catherine of
Siena, Wake Forest; and Parishioners Ms. Elizabeth Konrad, St. Catherine of
Siena, Wake Forest; Mr. Phil List, St. Joseph, Raleigh, Ms. Melissa Misko,
St. Francis of Assisi, Raleigh; and Ms. Chelsea Smith, St. Patrick, Fayetteville
Come and learn about young adult groups in our parishes and how to grow this
ministry as a New Evangelization tool. You’ll be introduced to how young adults
are using modern technology to contribute to the Church and to support their own
faith formation.
MARRIAGE … TILL DEATH DO US PART?
A-26 or
C-26
Monsignor Jerry M. Sherba, JCD, Vicar Judicial and Chancellor,
Tribunal, Diocese of Raleigh
What happens when a marriage fails and a party wishes to remarry? The
declaration of nullity process involves not only the parties and witnesses, but also
the ministry of advocates who speak for and represent the parties. This workshop
presents the role of the advocate (including the training provided), describes the
process, and encourages involvement in this specialized and vital ministry.
ONLINE REGISTRATION AVAILABLE! Visit www . di o ces eo f ra le igh .o r g
R EGISTRATION I NFORMATION
 Please indicate a 1st and 2nd workshop choice for each session; your choices will be honored as closely as possible.
 Lunch will be served during Sessions A, B and C. Please choose a lunch session. Eating in classrooms is not permitted.
 Group registrations may be submitted either online or by hard copy form (see the Group Registration Form available
on the diocesan website).
 Children must be registered by October 10 to attend the Children’s Track - Parent must also be a registered Convocation
participant. Child must be toilet-trained in order to attend.
 Parish Billing: Registration payments billed to a parish must be approved in advance by the pastor or his delegate.
 Participants may register on the day of Convocation-rate is $50. Some workshops may be full. Space is limited.
 Scholarships are available. Don’t let finances keep you away. Send request to: [email protected].
 Registration confirmation will be sent via e-mail or first class US Postal Service. Workshop selection assignments will appear
on your name tag at check-in on the day of Convocation.
 CEU’s for certification are available for Catholic school teachers who attend. Master Catechists will receive renewal hours.
 To receive a registration brochure by mail, call 919.645.4447 or email [email protected].
 For assistance with registration, contact the Registrar at 919.821.8156 or e-mail: [email protected].
 Cancellations received by October 10, 2014 will receive a full refund. No refunds will be available after that date.
I NFORMACION
PARA
I NSCRIPCIÓN
 Por favor, indique su primera y segunda elección para cada sesión; su elección se respetará en la mayor medida posible.
 El almuerzo se servirá durante las sesiones A, B y C. Por favor escoja una sesión para el almuerzo. Está prohibido comer en los
salones de clase.
 Las inscripciones por grupos se pueden realizar en línea o completar el formulario (véase el Formulario de Inscripción por Grupo
disponible en la página web diocesana).
 Niños y niñas deben estar inscritos antes del 10 de octubre para atender el Taller para niños – Los padres deben ser participantes
de la Convocatoria. Los niños y niñas deben estar entrenados para usar el baño para poder asistir.
 Cobro a la parroquia: para enviar el cobro de registro a la parroquia debe ser aprobado con anticipación por el Párroco o por
la persona designada.
 Los participantes pueden inscribirse el día de la Convocatoria, el costo es de $50. Algunos talleres pueden llenos saturados. El
espacio es limitado.
 Hay becas disponibles. No permita que la falta de dinero sea un obstáculo. Envíe su solicitud a:[email protected].
 La confirmación de registro se enviará por vía correo electrónico o por correo ordinario. Las asignaciones de selección de los
talleres aparecerán en su gafete en la verificación de registro el día de la Convocatoria.
 Los certificados de CEU para los maestros/as de escuelas católicas que asistan, estarán disponbles. Los Formadores Catequistas
recibirán horas renovadas.
 Para recibir un folleto de inscripción por correo ordinario llame al 919.645.4447 o pídalo al correo electrónico
[email protected].
 Para asistencia con la inscripción, comuníquese con Andrea Stone al 919.821.8156 o correo electrónico [email protected].
 Si usted cancela antes del 10 de octubre de 2014, recibirá una devolución completa. No habrá devoluciones después de esa fecha.
CATHOLIC CONVOCATION ~ OCTOBER 18, 2014
R EGISTRATION F ORM
C ONTACT I NFORMATION
Name__________________________________________________________________________________
)
PRINT
Address________________________________________________________________________________
ASE
E
L
P
(
Early
Bird
Regist
ration
due by
Septem
ber 5
City, State, Zip___________________________________________________________________________
E-Mail__________________________________________________________________________________
Please provide email address to receive confirmation
Cell Phone___________________________________________________________________________
Octo
be
Parish/Office/School______________________________________________________________________
R EGISTRATION R ATES - Check box
On or Before SEPT. 5  $35 Individual
From SEPT. 6-OCT. 10  $40 Individual
GROUP FORMS AVAILABLE ONLINE
 $30 Each/Groups of 5 or more
 $35 Each/Groups of 5 or more
(After October 10, participants must register at the door)
Day of/At the Door
 $50 Individual………No group rates available
C OSTO DE I NSCRIPCIÓN
- Marque la Casilla
FORMULARIOS DE GRUPO DISPONIBLES
EN LÍNEA PÁGINA WEB
Antes del 5 de Septiembre  $35 por persona
 $30 por persona/Grupos de 5 o más
Del 6 de Sept.-10 de Octubre  $40 por persona  $35 por persona/Grupos de 5 o más
Después del 10 de octubre, los participantes deberán inscribirse el día del evento
El precio en la entrada es de $50  por persona……… No habrá ofertas especiales para grupos
 CHILDREN’S TRACK
Limited Spaces Available, Pre-Registration Required / Cupos limitados - Se requiere una pre-inscripción
Name
______________________
______________________
______________________
W ORKSHOP

AND
Name
______________________
______________________
______________________
____
____
____
Age/Años
3-11
____
____
____
CASH CHECK CREDIT CARD
— OR —
 Bill Parish - Parish #_____________
 Diocesan Department #__________
Pastor/Authorized Delegate
Signature Required:
____________________________
Visa or
Mastercard
__________________________________
Name as it appears on card
____
____ ____ ____
Credit Card Number
Exp Date_
_ /_ _
Cardholder’s Address & Phone Number
This track is held during Sessions A and B,
lunch included. Participant needs to also choose
workshops below for Sessions C and D.
We apologize that we are unable to
accommodate specific dietary restrictions.
LUNCH  Turkey or  Vegetarian
O PCIÓNES D E P AGO
_ _ _ (3-digit Security Code on back of card)
L UNCH S ELECTION
HUMAN LIFE & DIGNITY
TRACK
P AYMENT O PTIONS
CREDIT CARDS ACCEPTED
/ TALLER PARA NIÑOS $5/each
Age/Años
3-11
10 r
Select one (1) lunch session and choose up to three (3) workshops.
(If different from registrant’s name)
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________
Cardholder Signature
Seleccione una (1) sesión para el almuerzo y escoja hasta tres (3) talleres.
LUNCH SESSION (CHOOSE ONLY ONE) A
B C
WORKSHOP CHOICES
Session A (10:45-11:55) A#_______
(2nd Choice) A#_______
Session C (1:35-2:45) C#_______
(2nd Choice) C#_______
Session B (12:10-1:20) B#_______
(2nd Choice) B#_______
Session D (2:55:4:05) D#_______
(2nd Choice) D#_______
 Cancellations received by October 10, 2014 will receive a full refund. No refunds after that date.
P AYMENT E NCLOSED
$__________
Make checks payable to:
DIOCESE OF RALEIGH
Mail to: Diocese of Raleigh
Attn: Registrar
7200 Stonehenge Drive
Raleigh, NC 27613
FOR OFFICE USE ONLY: Date Rec’d_________ Check #:__________Check Date:__________ Cash: ___________ CC: _____ Confirmation Sent:_______