Certificate of Election

 

Please verify all information is correct before submitting. If you do not have an elected Ex Officio Delegate(s), please indicate by filling in the space with "None Elected."
Name/Position of Individual Submitting Report *
First Name
Middle
Last Name
E-mail of Person Submitting Report*
Please List Name, Email, and Phone Number for Your Church D.A. Contact Person (This person should be the one who will be picking up delegate packets for the church delegates)
When you do plan to pick up the delegate packets?
Church Name*
Assembly Date*
Ex Officio Delegates (Members of the district assembly by virtue of office for the new assembly year). According to Manual 201 department heads (or their Vice) elected to serve in the new church year represent your church at the District Assembly not the officers during the past year. If for some reason you did not elect someone to fill one of the required spaces below, please place NA in that box.
NMI President
Email of NMI President
Contact Information - If new (If this is a newly elected person please provide their address and phone number.)
NMI Vice President
Email of NMI Vice President
Contact Information - If new. (If this is a newly elected person please provide their address and phone number.)
NYI President
Email of NYI President
Contact Information - If new. (If this is a newly elected person please provide their address and phone number.)
NYI Vice President
Email of NYI Vice President
Contact Information - If new. (If this is a newly elected person please provide their address and phone number.)
SDMI President
Email of SDMI President
Contact Information - If new. (If this is a newly elected person please provide their address and phone number.)
SDMI Vice President
Email of SDMI Vice President
Contact Information - If new. (If this is a newly elected person please provide their address and phone number.)
Total Church Membership Count (Please type the total number of members on your church role)*
ADDITIONAL DELEGATES. (If your church is eligible for more than 10 delegates, type in the appropriate range to reach the total number of delegates allowed - 1 delegate per extra 50 members - for your church membership. The Board of General Superintendents issued a ruling in 1998 that the pastor may name the eligible delegates based on the appropriate chart above If the church is a Church-Type Mission that has members.) *
Lay Delegates (The following lay delegates have been duly elected to represent our church at the District Assembly according to Manual 201.1 or 201.2. Please enter your delegates name and email below, each name/email entry separated by comma) *
Alternate Lay Delegates (Please enter your alternate delegates name and email below, each name/email entry separated by comma)
Ordained Elder Delegates (Please least all the names and emails of the de-facto elder delegates who will be attending D.A. from your church)
Please type the initials of person submitting the report*
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