Official Members Form

Pastoral Charge*

Name of individual submitting information*

Submitter's First Name Submitter's Last Name

Email of individual submitting information*

Phone of individual submitting information*

How many members are you entitled to? (In addition to your Minister)*

Minister

Is there a Minister?*

Yes
No

Minister's Name

First Last

Minister's Address

Street Address Address Line 2 City Province Postal Code

Minister's Phone

Minister's Email

Minister 2

Minister 2 Name

First Last

Minister 2 Address

Street Address Address Line 2 City Province Postal Code

Minister 2 Phone

Minister 2 Email

Members and Alternates

Please list your elected members and alternates for First Dawn Eastern Edge Regional Council. Alternates must be from the same congregation.

Member 1

Member 1 Name

First Last

Member 1 Address

Street Address Address Line 2 City Province Postal Code

Member 1 Phone

Member 1 Email

Member 1 Congregation

Is there a Member 2?

Yes
No

Is there an alternate for Member 1?

Yes
No

Alternate for Member 1

Alternate for Member 1 Name

First Last

Alternate for Member 1 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Alternate for Member 1 Phone

Alternate for Member 1 Email

Alternate for Member 1 Congregation

Member 2

Member 2 Name

First Last

Member 2 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Member 2 Phone

Member 2 Email

Member 2 Congregation

Is there a Member 3?

Yes
No

Is there an alternate Member for Member 2?

Yes
No

Alternate for Member 2

Alternate for Member 2 Name

First Last

Alternate for Member 2 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Alternate for Member 2 Phone

Alternate for Member 2 Email

Alternate for Member 2 Congregation

Member 3

Member 3 Name

First Last

Member 3 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Member 3 Phone

Member 3 Email

Member 3 Congregation

Is there a Member 4?

Yes
No

Is there an alternate Member for Member 3?

Yes
No

Alternate for Member 3

Alternate for Member 3 Name

First Last

Alternate for Member 3 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Alternate for Member 3 Phone

Alternate for Member 3 Email

Alternate for Member 3 Congregation

Member 4

Member 4 Name

First Last

Member 4 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Member 4 Phone

Member 4 Email

Member 4 Congregation

Is there a Member 5?

Yes
No

Is there an alternate Member for Member 4?

Yes
No

Alternate for Member 4

Alternate for Member 4 Name

First Last

Alternate for Member 4 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Alternate for Member 4 Phone

Alternate for Member 4 Email

Alternate for Member 4 Congregation

Member 5

Member 5 Name

First Last

Member 5 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Member 5 Phone

Member 5 Email

Member 5 Congregation

Is there a Member 6?

Yes
No

Is there an alternate Member for Member 5?

Yes
No

Alternate for Member 5

Alternate for Member 5 Name

First Last

Alternate for Member 5 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Alternate for Member 5 Phone

Alternate for Member 5 Email

Alternate for Member 5 Congregation

Member 6

Member 6 Name

First Last

Member 6 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Member 6 Phone

Member 6 Email

Member 6 Congregation

Is there an alternate Member for Member 6?

Yes
No

Alternate for Member 6

Alternate for Member 6 Name

First Last

Alternate for Member 6 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Alternate for Member 6 Phone

Alternate for Member 6 Email

Alternate for Member 6 Congregation

Official Members Form