DELEGATE CREDENTIAL FORM
Please complete the following information by May 25.

This certifies that the following delegate(s) were duly elected as a Lay or Alternate Delegate to the Annual Conference of the Northwest District of the Wesleyan Church of America, to be held in Rapid City, South Dakota on June 26, 2019.

Email address *
Church
Your answer
Name of LBA Secretary
Your answer
Email of LBA Secretary
Your answer
Date lay and alternate delegate(s) were elected
MM
/
DD
/
YYYY
How many delegates are allocated to your church? *
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