SFD Delegate Certificate of Election for DA 4 Jan 26

Certificate of Election Delegates to the District Assembly
District Assembly and Conventions 2026
Southern Florida District Church of the Nazarene
April 9-11, 2026
Lake Placid Camp and Conference Center
2665 Placid View Dr., Lake Placid, FL 33852

Information Due: February 28, 2026

Voting at District Assembly and Conventions
All voting at District Assembly and Conventions 2026 will be online.
All Reports are online only.
All Delegates will receive information by text and email for voting at District Assembly and Conventions 2026.
We will use information in this form; to give delegates and others access to vote at District Assembly and Conventions.
Unable to accept any paper reports for District Assembly and Conventions.
Local Church
Local Church*
Other Church
Year End Membership*
Ex-Officio Delegate
Lead Pastor (Attending Assembly)
Lead Pastor*

First NameLast Name
Lead Email*
example@example.com
Lead Cell Phone Number*
Please enter a valid phone number.
Add Co-Pastor Information

YesNo
Co-Lead Pastor

First NameLast Name
Co-Lead Pastor Email
example@example.com
Co-Lead Pastor Cell Phone Number
Please enter a valid phone number.
Board Secretary Name*

First NameLast Name
Board Secretary Email*
example@example.com
Board Secretary Phone Number*
Please enter a valid phone number.
NMI President
NMI President Name

First NameLast Name
NMI President Email
example@example.com
NMI President Cell Phone Number
Please enter a valid phone number.
NDI Chair
NDI Chair Name

First NameLast Name
NDI Chairt Email
example@example.com
NDI Chair Cell Phone Number
Please enter a valid phone number.
NYI President
NYI President Name

First NameLast Name
NYI President Email
example@example.com
NYI President Cell Phone Number
Please enter a valid phone number.
Elected Delegates to District Assembly
District Assembly Delegate #1
Delegate #1

First NameLast Name
Delegate #1 Email
example@example.com
Delegate #1 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #2
Delegate #2

First NameLast Name
Delegate #2 Email
example@example.com
Delegate #2 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #3
Delegate #3

First NameLast Name
Delegate #3 Email
example@example.com
Delegate #3 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #4
Delegate #4

First NameLast Name
Delegate #4 Email
example@example.com
Delegate #4 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #5
Delegate #5

First NameLast Name
Delegate #5 Email
example@example.com
Delegate #5 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #6
Delegate #6

First NameLast Name
Delegate #6 Email
example@example.com
Delegate #6 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #7
Delegate #7

First NameLast Name
Delegate #7 Email
example@example.com
Delegate #7 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #8
Delegate #8

First NameLast Name
Delegate #8 Email
example@example.com
Delegate #8 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #9
Delegate #9

First NameLast Name
Delegate #9 Email
example@example.com
Delegate #9 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #10
Delegate #10

First NameLast Name
Delegate #10 Email
example@example.com
Delegate #10 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #11
Delegate #11

First NameLast Name
Delegate #11 Email
example@example.com
Delegate #11 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Delegate #12
Delegate #12

First NameLast Name
Delegate #12 Email
example@example.com
Delegate #12 Cell Phone Number
Please enter a valid phone number.
Alternates Delegates to District Assembly
District Assembly Alternates Delegate #1
Alternates Delegate #1

First NameLast Name
Alternates Delegate #1 Email
example@example.com
Alternates Delegate #1 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Alternates Delegate #2
Alternates Delegate #2

First NameLast Name
Alternates Delegate #2 Email
example@example.com
Alternates Delegate #2 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Alternates Delegate #3
Alternates Delegate #3

First NameLast Name
Alternates Delegate #3 Email
example@example.com
Alternates Delegate #3 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Alternates Delegate #4
Alternates Delegate #4

First NameLast Name
Alternates Delegate #4 Email
example@example.com
Alternates Delegate #4 Cell Phone Number
Please enter a valid phone number.
Add Another Delegate

YesNo
District Assembly Alternates Delegate #5
Alternates Delegate #5

First NameLast Name
Alternates Delegate #5 Email
example@example.com
Alternates Delegate #5 Cell Phone Number
Please enter a valid phone number.
Submitter Info
Date*

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Signature*

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NMI President
Should be Empty:

Certificate of Election Delegates to the District Assembly

Local Church

Ex-Officio Delegate

Lead Pastor (Attending Assembly)

NMI President

NDI Chair

NYI President

Elected Delegates to District Assembly

District Assembly Delegate #1

District Assembly Delegate #2

District Assembly Delegate #3

District Assembly Delegate #4

District Assembly Delegate #5

District Assembly Delegate #6

District Assembly Delegate #7

District Assembly Delegate #8

District Assembly Delegate #9

District Assembly Delegate #10

District Assembly Delegate #11

District Assembly Delegate #12

Alternates Delegates to District Assembly

District Assembly Alternates Delegate #1

District Assembly Alternates Delegate #2

District Assembly Alternates Delegate #3

District Assembly Alternates Delegate #4

District Assembly Alternates Delegate #5

Submitter Info

NMI President