2019 Synod Convention Delegate / Alternate Information
This form is designed to provide initial information to the district secretary about the men who have been slated to serve as delegates to the 2019 synod convention. If you will be serving as a delegate you will get a separate registration form to actually register as a delegate. (This is not that form.)
Last Name*
First Name*
Choose One*
 Pastor Delegate
 Pastor Alternate
 Teacher / Staff Minister Delegate
 Teacher / Staff Minister First Alternate
 Teacher / Staff Minister Second Alternate
 Delegate Congregation Lay Delegate
 Delegate Congregation Substitute
 Alternate Congregation Lay Delegate
 Alternate Congregation Substitute
Street Address*
City, ST zip*
Preferred Phone Number*
Preferred Email Address*
 I am able to serve as a delegate.
 I am NOT able to serve as a delegate
If unable to serve, please list the reason.
Lay delegates/alternates, please also answer the following questions...
Congregation, City, and STate
 Still Working
Age: (as of July 31, 2019)