Certificate of Voting Delegates

Certificate of Voting Delegates

For the Oklahoma “Called” Regional Assembly on June 28, 2025
Name of Church*
Church City*
Person Submitting this Form*
Submitter Email*
example@example.com
Submitter Phone Number*
Please enter a valid phone number.
Certified Voting Lay Delegates for
Called Regional Assembly 6-28-2025
Delegate #1 Name*
Delegate #1 Email*
example@example.com
Delegate #1 Address

Street Address

Street Address Line 2

CityState

Zip Code
Delegate #1 Attending & Voting*

In-PersonOnline
Delegate #2 Name
Delegate #2 Email
example@example.com
Delegate #2 Address

Street Address

Street Address Line 2

CityState

Zip Code
Delegate #2 Attending & Voting

In-PersonOnline
Delegate #3 Name
Delegate #3 Email
example@example.com
Delegate #3 Address

Street Address

Street Address Line 2

CityState

Zip Code
Delegate #3 Attending & Voting

In-PersonOnline
Delegate #4 Name
Delegate #4 Email
example@example.com
Delegate #4 Address

Street Address

Street Address Line 2

CityState

Zip Code
Delegate #4 Attending & Voting

In-PersonOnline
Add Delegate #5

YesNo
Delegate #5 Name
Delegate #5 Email
example@example.com
Delegate #5 Address

Street Address

Street Address Line 2

CityState

Zip Code
Delegate #5 Attending & Voting

In-PersonOnline
Add Delegate #6

YesNo
Delegate #6 Name
Delegate #6 Email
example@example.com
Delegate #6 Address

Street Address

Street Address Line 2

CityState

Zip Code
Delegate #6 Attending & Voting

In-PersonOnline
Alternate Delegate Name
Alternate Delegate Email
example@example.com
Alternate Delegate Address

Street Address

Street Address Line 2

CityState

Zip Code
Alternate Delegate Attending & Voting

In-PersonOnline
Certified By Board Chair/Moderator
Board Chair/Moderator Name*
By checking this box I certify this as my digital signature.*

Board Chair/Moderator
Date*

MonthDayYear
Date
Name of Church
Church City
Should be Empty:

Certificate of Voting Delegates

Certified Voting Lay Delegates forCalled Regional Assembly 6-28-2025

Certified By Board Chair/Moderator

Certified Voting Lay Delegates for
Called Regional Assembly 6-28-2025