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Diocese of the Central States - 2017 Synod Registration
Please complete all blocks.
Thank you for using this on-line registration form.

When you complete this form and press the
Send Now button (at the bottom of the form)
the form will be sent to our Synod registar. No sensitive information is collected with this form.

Notes:

  • Up to two registrations may be submitted on a single form. If you have more than two registrations to submit, please submit multiple forms.
  • When you have filled in all of the information for your attendees, scroll to the bottom and send the form.
  • If you are registring yourself, you still need to complete the submitter information at the top.
  • A partially completed form cannot be saved for later use.
  • All fees will be collected during check-in. We are not able to accept credit cards. Only cash or checks are acceptable. Checks must be made payable to Trinity REC.
  • For techical support or to report problems write to Andy Figueroa

(REQUIRED) Form Submitters Name	, Email ,
Phone Number			, Congregation 

PERSON(S) BEING REGISTERED:

#1
Title: 			
First Name:		
Middle Name/Initial: 	
Last Name:		
Suffix (Jr, III):	
Known As for name tag:	
Status:			 (complete if "Other" selected)
Affiliation(if not REC):
Home Mailing Address:	 City:	 State:  Zip Code:
Email Address:		
Home Phone:		
Cell Phone:		
Estimated Arrival:	
Mode of Transportation:	

Attending Banquet?	YES or NO

The banquet will be a sumptuous buffet as detailed in the synod invitation on the diocesan web site. The cost is $60
in addition to the $60 base synod registration fee. If attending as a synod volunteer, you must still pay for the banquet.


Any special food requirements or other needs?


#2
Title: 			
First Name:		
Middle Name/Initial: 	
Last Name:		
Suffix (Jr, III):	
Known As for name tag:	
Status:			 (complete if "Other" selected)
Affiliation(if not REC):
Home Mailing Address:	 City:	 State:  Zip Code:
Email Address:		
Home Phone:		
Cell Phone:		
Estimated Arrival:	
Mode of Transportation:	
Attending Banquet?	YES or NO

The banquet will be a sumptuous buffet as detailed in the synod invitation on the diocesan web site. The cost is $60
in addition to the $60 base synod registration fee. If attending as a synod volunteer, you must still pay for the banquet.


Any special food requirements or other needs?


SEND NOW?
To clear form of all typing and start over, press the RESET button.  

THANK YOU!

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