Nomination Form

*** Use TAB or click-select to move from field to field***

Position Nominated for: Rocky Mountain Synod Secretary

Name (First Mi Last): Click or tap here to enter text.

☐ Lay (click box to select/unselect)
☐ Lay Roster (click box to select/unselect)
☐ Clergy (click box to select/unselect)

Occupation: Click or tap here to enter text.

Conference/Geography: Click or tap here to enter text.

Home Congregation: Click or tap here to enter text.
How Long? Click or tap here to enter text.

Briefly describe your sense of God’s call into mission and service in the Synod through this office:

Click or tap here to enter text.

Briefly describe your skills and experiences that would be an asset to this office:

Click or tap here to enter text.

List three current or past congregational and synodical service activities:

1. Click or tap here to enter text. from Click or tap to enter a date. to Click or tap to enter a date.

2. Click or tap here to enter text. from Click or tap to enter a date. to Click or tap to enter a date.

3. Click or tap here to enter text. from Click or tap to enter a date. to Click or tap to enter a date.

NOTE:	FOR SYNOD OFFICE USE ONLY. THIS INFORMATION WILL NOT APPEAR ON THE ASSEMBLY WEBSITE

Gender: Click or tap here to enter text.

Primary Language: Click or tap here to enter text.

Ethnic: Click or tap here to enter text.

Racial Group: Click or tap here to enter text.

Mailing address: (☐ work or ☐ home)

Street, Apt#, Unit: Click or tap here to enter text.

City, State, Zip: Click or tap here to enter text.

Telephone:

(Preferred) Click or tap here to enter text. (☐ work or ☐ home)
(Alternate) Click or tap here to enter text. (☐ work or ☐ home)

E-mail: (☐ work or ☐ home)

Click or tap here to enter text.

If not elected, may we keep your name on file for future years?

(☐ YES or ☐ NO)