PSD Convention - Non-Voting Advisory Delegate

Preliminary Advisory Voting Commissioned Ministers and Non-Voting Advisory Delegate Signup

This form is for Preliminary Advisory Voting Commissioned Ministers (PAVCM) and Non-Voting Advisory Delegates to sign up for convention participation.
Type of Delegate*

Preliminary Advisory Voting Commissioned MinisterNon-Voting Advisory Delegate
Type of Non-Voting Advisory Delegate

Ordained Minister (not serving as the voting delegate for his congregation)Commissioned Minister
Delegate Contact Information
Name*

First NameLast Name
Type of Commissioned Minister
If Other please explain
Roster Status*

ActiveCandidateEmeritus
Currently Called to
i.e Walther Elementary
Call City & State*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Currently called as
i.e. DCE, 5th grade math teacher, church administrator, etc.
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Congregation Information

By completing this form, you are certifying that the listed individual will represent the congregation as a Preliminary Advisory Voting Commissioned Minister or a non-voting advisory delegate at the 47th Convention of the Pacific Southwest District of LCMS which will convene at the La Quinta Resort, La Quinta, CA, June 25-27, 2025
The congregation below should be the one in which the delegate is a member, not necessarily the organization to which they are called (i.e. school, university, RSO).
Congregation Name*
Congregation City & State*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of person from congregation completing this form

First NameLast Name
My email address
example@example.com
I am completing this form as

PastorCongregational Officer
Select One

Our Congregation has at least one called & installed pastorOur Congregation is vacant (i.e. being served by a vacancy pastor, pulpit supply, only a vicar, etc.)

Relevant Experience

Relevant Experience is optional but may aid the Convention Committee in solicitation of Floor Committee members
Previous Experience as a Convention Delegate, if applicable (list years and/or committees)
Congregation/District/Synod Experience (i.e. Boards, Committees) (include years)
Political/Civic Experience (i.e. Elected Office, Clubs) (include years)
Should be Empty:

Preliminary Advisory Voting Commissioned Ministers and Non-Voting Advisory Delegate Signup