Information Form For Election
To The 2004 General And North Central Jurisdictional Conferences
Northern Illinois Annual Conference
Laity

The 2004 General Conference will be held April 25 through May 7, 2004 in Pittsburgh, PA.  The 2004 Jurisdictional Conference will be held July 12 through July 14, 2004 in Davenport, Iowa. 

Please complete ALL of the following areas: 

Name:                                                                                                                                               

Address:                                                                                                                                           

City:                                                                                     State:                    Zip:                        

Telephone:(          )                                         

E-mail address:                                                                                                                                

I have been a member of                                                     Church for at least two years and I attest that
I have been active in the United Methodist Church for at least four years.
District:                                                                                   

Please describe in 150 words or less your most recent responsibilities in your local church:

Please describe in 150 words or less your most recent responsibilities on your district:




 

Please describe in 150 words or less your most recent responsibilities on the Conference level:




 

Please describe in 150 words or less your most recent United Methodist responsibilities beyond the Northern Illinois Conference:





 

Please describe in 150 words or less your involvement in your community or other groups that would be an asset to the delegation:




 

Please give a brief biographical statement about yourself, your family, your work and other things about you
that those voting need to know:




 

Please indicate anything else you bring to the delegation that would enhance your representation
of the Northern Illinois Annual Conference:




 

By signing this form, I agree to fully participate in the work of the delegation from election through the final session.

Signature:                                                                                                                                                                                        

Date:                                              

If you wish to ONLY stand for election to the Jurisdictional Delegation, please check here _____