This form may be reproduced.

You may nominate only one participant from your congregational unit.

Be sure you have her permission.

NAME OF NOMINEE________________________________________________________

ADDRESS________________________________________________________________

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PHONE ___________________________

DATE_________________________________

CONGREGATIONAL UNIT__________________________________________________

CONFERENCE____________________________________________________________

Does Nominee qualify for either category?

(___) Person of color and/or person whose primary language is other than English

(___) Person with a disability (i.e. hearing or sight impaired, physically impaired, etc.)

Highlights of present and past activities in Women of the ELCA, congregations, conference, synod, churchwide, community and career:

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

By attending as a delegate, what do you hope to bring to the Upstate NY Synod Women of the ELCA?

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

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Submitted by _________________________________ with the permission of the nominee.

Congregational Unit Representative

Nominee Signature_________________________________________________________