28th Annual Synod Assembly

Northeastern Pennsylvania Synod, ELCA

May 29-30, 2015

Santander Arena, Reading, PA

ASSEMBLY REGISTRATION FORM

NOTE:Register for the 2015 assembly online at Follow the link to the synod assembly on the home page. Use the form below as a guide for your online registration. You may also use this form to register by mail. Please note there is a discount of $10 for online registrationsif completed by midnight May 8.The deadlinefor all registrations is May 15.Complete one form per person.

NAME:______

HOME ADDRESS:______

______

HOME TELEPHONE(including area code): ______

EMAIL ADDRESS: ______

NICKNAME/NAME TO APPEAR IN LARGE PRINT ON BADGE: ______

CONGREGATION/AGENCY:______

LOCATION OF CONGREGATION/AGENCY:______

CHECK ALL THAT APPLY:

□ Male □ Female

□ Pastor MISSION DISTRICT (check one

Please See Reverse Side

□ Associate in Ministry□ Bethlehem/Easton

□ Deaconess□ East Berks

□ Diaconal Minister□ Hazleton/Lehighton

□ Lay Voting Member□ Lehigh

□ Candidate for Rostered Status this year□NorthernLehighValley

□ Synod Council Member□ Pocono

(not congregational voting member)□Schuylkill

□ Synodically Authorized Lay Minister□ Scranton/Wilkes-Barre

□ Visitor□ West Berks

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CHECK ALL THAT APPLY

□I need large print documents.

□This is my first synod assembly.

□I request that my registration fee be paid by the synod. I am a --

□retired rostered leader not serving a congregation.

□candidate approved this year for rostered status and eligible for a call.

□member of synod council who is not a congregational voting member.

FEES (fill in all that apply)

REGISTRATION FOR VOTING MEMBER:

$160.00by mail until midnight May 8 / $
$170.00 by mailfrom May 9 throughMay 15when registration closes / $

REGISTRATION FOR FULL-TIME VISITORS:

$160.00 by mail(postmarked by May 8) / $
$170.00 by mail from May 9 through May 15when registration closes / $

DAY VISITORS: There is no registration fee.Dinner tickets can be purchased below.

FRIDAY NIGHT BANQUET -- TICKETS MUST BE ORDERED IN ADVANCE by May 15.

If you plan to attend the banquet on Friday, please complete the form below and include payment.

# / Entrée choice / $22.00 each
Herb Stuffed Chicken Breast topped with white wine cream sauce
Pasta Primavera in a creamy red pepper pesto sauce
BBQ Pork Chop with crispy fried onions
Gluten-free meal: chicken – #_____ pork – #______
Total Due / $

If registering by mail, complete this form for each person and send all the forms with a check to: ASSEMBLY - NEPS Registration, 2354 Grove Road, Allentown, PA, 18109-3044

Make checks payable to: Northeastern PA Synod.

Checks for all registrations must be received in the synod office by May 22.

NOTE: There is an additional $10.00 fee for anyone waiting until the Assembly to pay.

REGISTRATION FINAL DEADLINE: MAY 15

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