Nomination Form Even Year
Are you nominating yourself or someone else? If someone else, please obtain their consent prior to submitting a form.
 Other, consent obtained
Nominated for the office of: (check all that apply)
 Vice President
 Communications Coordinator
 Pastoral Advisor
First Name:*
Last Name:*
Zip/Postal Code:*
Phone Number:*
E-mail address:*
Please provide a brief description of your computer skills:
What is your occupation?
Marital Status:
If married, spouse's name:
Family members:
Name and address of nominee's congregation:*
Name of nominee's circuit:
Please describe the nominee's LWMS activities, positions and organizational involvement in the present and past:
Please describe the nominee's service to the local congregation in the present and past:
Please provide professional, work or volunteer experience which relates to the duties of the office for which this person is being nominated:
Please provide any other information which may help form a "mental" picture of the individual, and be of benefit to the board of directors in assessing the talents and capabilities of this nominee:
Upon receipt of this nomination form, you will receive an email. Please attach a recommendation provided by the pastor or the nominee's home congregation. Pastoral Advisor nominees do not need to submit a recommendation.
Nominations are due by January 1, 2022. Thank you for your nomination.
Submitted by:*
Phone number:*
E-mail address:*
Congregation name, city and state: