Nominee Form This is the Nominee Form for the Charlottesville District At-Large Lay Delegate Annual Conference 2015 Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Your Age*Young Person 18 - 30Youth 12-17OtherYour Gender*MaleFemaleYour Ethnic BackgroundName of Local ChurchI have held the following position at my local churchI have held the following position at the Annual ConferenceI have held the following position on the District asI am presently serving in my local church asI am presently serving on the Annual Conference level asI am presently serving on the District asBy submitting this form you are giving your consent to have your name placed on the ballot for election of the Annual Conference. If elected you will be able to attend.
