Registration Form - 2018 Southern District Convention
Title *
First Name *
Your answer
Last Name *
Your answer
Street Address *
or P.O. Box
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Please use the following format: "504-289-6481."
Your answer
Email Address *
All Voting Delegates must have an email address. If you are not a Voting Delegate and do not have an email address, enter "none."
Your answer
Accompanied by Spouse *
First Name of Spouse
(required if spouse is attending)
Your answer
Last Name of Spouse
(required if spouse is attending)
Your answer
Emergency Contact Person *
Please list the name of a person who we may contact for you in case of an emergency.
Your answer
Emergency Contact Phone Number *
Please list the emergency person's phone number, using the following format: "504-289-6481."
Your answer
Congregation or School You Are Representing: *
Your answer
Congregation or School City *
Your answer
Congregation or School State *
Your answer
Presenter Organization
If you are a presenter, what organization do you represent?
Your answer
Exhibitor Organization
If you are an exhibitor, what organization do you represent?
Your answer
Attending as *
Friday Lunch *
Please select the number of attendees. If your spouse is completing a separate registration form, each of you should choose "1."
Submit
Never submit passwords through Google Forms.
This form was created inside of Southern District - LCMS. Report Abuse - Terms of Service