Name:
Street Address:   City:
Phone: E-mail:

Church:

Registration Deadline is February 10th

Workshop Selection (you will only be able to attend 1 workshop)       

Lay Equalization Member to Annual Conference

I would like to be placed on the ballot as a nominee for Lay Equalization Member to Annual Conference:

Name:
Address:
Phone:
E-mail:
Church:

Youth (13 - 25) & Birthday: