Pre-registration Form

Pre-Registration
Name of your congregation
Name of Congregation*
Your email address for responses*
example@example.com
Step1: 2024 Virlina District Conference Delegates

(Please refer to congregation list to find outhow many delegates you may send.)
Pastor (Automatic Delegate)

First NameLast Name
Chair of Board (Automatic Delegate)

First NameLast Name
3rd Elected Delegate

First NameLast Name
4th Elected Delegate

First NameLast Name
5th Elected Delegate (251+)

First NameLast Name
Total number of delegates
Total amount to submit
If your congregation has to send an alternate delegate in a registered delegate’s place, please alert the District Office of this change as soon as possible. (540) 362-1816
The registration fee is $30.00 per delegate. Registration forms and payment are due by September30. This registration form will help determine how many conference booklets are printed. Mail form and payment (checks made payable to Virlina District) to: Virlina District Resource Center, 3402 Plantation Road NE, Roanoke, VA 24012
Should be Empty:

Pre-Registration