* required
Parish or Institution Name*:
Parish/Institution Location: city*
state*
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Name of Lay Delegate*:
Delegate's Phone Number* (with
area code):
Work or Cell Phone Number, if available* (with
area code):
Delegate's E-Mail Address, if available:
Delegate's Mailing Address*:
Delegate's City*:
State*:
Zip*:
Do you plan to attend the banquet?
Please make a selection:
Yes, I plan to attend the banquet
No, I will not attend the banquet
To be validly elected, qualified and
accredited, the Lay Delegate to the Diocesan Assembly must meet the
requirements as set forth in the Statute of the Orthodox Church in
America, Art. VII, Sec. 6.
The above delegate was selected at a
Date of selection of delegate (mm/dd/yy)*:
Rector*:
NOTE: You are responsible
for making your own lodging arrangements.
The Assembly fee and Banquet fee for Lay Delegates are
covered by the parish Assembly Assessment.
Delegate transportation and lodging costs are
not covered by the Assessment but they are the responsibility
of the parish.
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registration before submitting it
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