Annual Conference is a ministry of the Church of the Brethren.

Nominee Information Form

For the Nominating Committee of Standing Committee

Someone has nominated me, and I am willing to be considered as a candidate for the office of
Moderator-Elect	Bethany Seminary Trustee - Laity
Program and Arrangements Committee	Mission and Ministry Board - Area 2
On Earth Peace Board	Mission and Ministry Board - Area 3
Church of the Brethren Benefit Trust Board	Pastoral Compensation and Benefits Advisory Council
Bethany Seminary Trustee - Clergy

Full Name
Age
Address
City
State
Zip
Home Phone
Cell Phone
E-mail Address

Occupation
Congregation
District
Gender	Female Male
Racial/Ethnic Background	Caucasian African American Hispanic Other:

Leadership positions you have held in the LOCAL Church
Leadership positions you have held at the DISTRICT level
Leadership positions you have held at the DENOMINATIONAL level
OTHER relevant leadership positions (community, professional, etc.)
Describe how these positions will provide you with the skills/experience needed for this nominated office
Please limit your response to the following to one sentence each.
Your VISION
Your PRIORITY
Your FAITH STATEMENT
Signature (typed)