RC15 Elected Members

Pastoral Charge*

Name of Other Ministry*

Congregation (Please List All)*

Name of individual submitting information*

Submitter's First Name Submitter's Last Name

Phone of individual submitting information*

Email of individual submitting information*

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

Minister

Minister's Name

First Last

Minister's Address

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

Minister's Phone

Minister's Email

Is there a second Minister?*

Yes
No

Minister 2

Minister 2 Name*

First Last

Minister 2 Address*

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

Minister 2 Phone*

Minister 2 Email*

Members and Alternates

Please list your elected members and alternates for Regional Council 15. Alternates must be from the same congregation.

Do you have elected members?*

Yes
No

Member 1

Member 1 Name*

First Last

Member 1 Address*

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

Member 1 Phone*

Member 1 Email

Member 1 Congregation*

Is there an alternate for Member 1?*

Yes
No

Is there a Member 2?*

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 Country

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 Country

Member 2 Phone*

Member 2 Email

Member 2 Congregation*

Is there an alternate Member for Member 2?*

Yes
No

Is there a Member 3?*

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 Country

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 Country

Member 3 Phone*

Member 3 Email

Member 3 Congregation*

Is there an alternate Member for Member 3?*

Yes
No

Is there a Member 4?*

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 Country

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 Country

Member 4 Phone*

Member 4 Email

Member 4 Congregation*

Is there an alternate Member for Member 4?*

Yes
No

Is there a Member 5?*

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 Country

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 Country

Member 5 Phone*

Member 5 Email

Member 5 Congregation*

Is there an alternate Member for Member 5?*

Yes
No

Is there a Member 6?*

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 Country

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 Country

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 Country

Alternate for Member 6 Phone*

Alternate for Member 6 Email

Alternate for Member 6 Congregation*

Minister

Minister 2

Members and Alternates

Member 1

Alternate for Member 1

Member 2

Alternate for Member 2

Member 3

Alternate for Member 3

Member 4

Alternate for Member 4

Member 5

Alternate for Member 5

Member 6

Alternate for Member 6

Share this:

United Church of Canada News