Application for Change in Clergy Relationship to the Annual Conference
Form 106
First Name
*
Middle Name
Last Name
*
Birth Date
*
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Month
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Day
Year
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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Louisiana
Maine
Maryland
Massachusetts
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Mississippi
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New Hampshire
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New York
North Carolina
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Ohio
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Pennsylvania
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South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Cell Phone Number
*
Other Phone Number
Email
*
example@example.com
Clergy Status
*
Please Select
Part-time Licensed Local Pastor
Full-time Licensed Local Pastor
Provisional Deacon
Provisional Elder
Full Deacon
Full Elder
Retired Full Deacon
Retired Full Elder
Affiliate Member
Associate Member
Retired Associate Member
Deacon Member of another AC
Deacon Member of another denomination
Elder Member of another AC
Elder Member of another denomination
Retired Licensed Local Pastor
Conference
*
District
*
Please Select
Annapolis
Baltimore Metro
Baltimore Suburban
Central Maryland
Cumberland-Hagerstown
Frederick
Greater Washington
Washington East
Other
I hereby request the following change in my relationship to the annual conference:
*
Discontinuance as a Local Pastor (¶320.1)
Discontinuance as a Provisional Member (¶377.6)
Appointment to Less than Full-Time Service (¶338.2)
Appointment to Extension Ministry (¶344.1)
Affiliate Membership Request (¶344.4)
Sabbatical Leave (¶351)
Voluntary Leave of Absence - Personal (¶353.2a)
Voluntary Leave of Absence - Family (¶353.2b)
Transitional Leave of Absence (Deacon) (¶353.2c (1))
Transitional Leave of Absence (Elder) (¶353.2c (2))
Returning to Active Status (¶353.11)
Maternity/Paternity Leave (¶355)
Medical Leave (¶356)
Retirement (¶357 or ¶320)
Honorable Location (¶358)
Withdrawal to Unite with Another Denomination (¶360.1)
Withdrawal from the Ordained Ministerial Office (¶360.2)
Withdrawal Under Complaints or Charges (¶360.3)
Category of Retirement
*
Not applicable
Between Sessions of the Annual Conference
Mandatory Retirement (¶357.1)
With 20 Years of Service (¶357.2a)
With 30 Years of Service or at Age 62 (¶357.2b)
With 40 Years of Services or at Age 65 (¶357.2c)
Full-Time Local Pastor (¶320)
Part-Time Local Pastor (¶320)
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