2021 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 represent the district as delegates or alternates to the 2021 synod convention. If you will be serving as a delegate you will get a separate registration form from President Schroeder's office to actually register as a delegate. (This is not that form.)
Last Name*
First Name*
Select 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
Preferred Phone Number*
Preferred Email Address*
Select one:*
 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...
Street Address
City, ST zip
Congregation, City, and STate
Occupation
 Still Working
 Retired
Age: (as of July 26, 2021)


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