District 
Church/Charge 
Last Name 
First Name 
Middle Name 
  Address Line 1 
Address Line 2  
Phone 
E-mail 

I am clergy  Yes  No

I plan to attend the 2008 Annual Conference June 11-14:   Yes      No  

Check this box if you are an alternate replacing a lay member: 

If you checked the box above what is the name of the Lay member you are replacing?