The deadline for advanced nominations has past. If you use this form, please print out your information and bring it to synod assembly for presentation with floor nominations.
This online form is designed to be filled out by the nominee. Upon completion, it sends an email to both the nominee and the nominator. The nominator must validate the nomination by email supplying his or her position, mailing address and phone number.

Nominations for Elections at Synod Assembly 2012

Complete this biographical form as indicated. Please fill all fields.

Title Select title Rev. Dr. Mr. Mrs. Ms.

First Name

Middle Name/Initial

Last Name

Suffix

Synod Position Select position Treasurer North Mission District-PCLE (Lay or Clergy) North Mission District - Clergy Southwest Mission District - Lay Female Southeast Mission District - Lay Male Youth Member Synod-wide - Lay Female Consultation Committee - Clergy Consultation Committee - Lay Discipline Committee - Clergy Discipline Committee - Lay

Churchwide Assembly Position Select position Lay Male Space Coast (4) Lay Male Lake (7) Lay Male Panhandle (10) Lay Male Tampa (13) Lay Female Flagler/Volusia (5) Lay Female Caloosa (11) Suncoast (14) Clergy Tradewinds (3) Clergy First Coast (6) Clergy Pinelands (9) Clergy Mid-Gulf (12) Clergy Gulf Coast (15) Youth/LF Heart of FL (8) PCLE/LM Miami/Dade (1)

Home Phone

Email

Address

City

State

Zip Code

Year of Birth

Gender Select gender Female Male

Check all that apply

Lay Clergy Youth under 18 Young Adult 18-35 PCLE

Check All Applicable Categories. PCLE means Person of Color or primary Language other than English

Occupation & Education Experience

Occupation

Primary Language Select option English Spanish Creole French Finnish German Other

Congregation & City

Enter in the form of: Grace, Tampa

Conference Choose conference 01-Miami-Dade/Monroe Conference 02-Broward-Bahamas Conference 03-Tradewinds Conference 04-Space Coast Conference 05-Flagler-Volusia Conference 06-First Coast Conference 07-Lake Conference 08-Heart of Florida 09-Pinelands Conference 10-Panhandle Conference 11-Caloosa Conference 12-Midgulf Conference 13-Tampa Conference 14-Sun Coast Conference 15-Gulf Coast Conference

Church Leadership & Participation

List Specific Gifts or Talents You Bring to Position (50 words or less)

Person Making Nomination

Email of Person Making Nomination

The person making the nomination will receive an email to validate the nomination and must reply for the nomination to be accepted.

Enter the code

Please Note:

1. If you are not redirected to a confirmation page after clicking on "Submit," please scroll up and check the form. All fields are required, except Middle Initial and Suffix, in order to submit the Nominations Form successfully.