Calling All Clergy Application
All Delta Clergy interested in participating in the 53rd Eastern Regional Conference must complete this form and submit to Rev. Natalie P. Alford, Eastern Regional Chair, Chaplains Council at dst.easternregchaplain@gmail.com. Please direct any questions to Eastern Regional Chair, Chaplains Council at dst.easternregchaplain@gmail.com.
Prefix
Dr.
Rev.
Minister
Chaplain
Clergy Status
Ordained
Licensed
Military Chaplain
Religious Affiliation/Denomination
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Cell Phone Number
-
Area Code
Phone Number
Member #
Chapter
(Full chapter name; no abbreviations)
Highlight Delta Clergy Council Experience/Previous Convention/Conference Experience
Submit
Should be Empty: