District Conference Delegate Registration This form is due by July 1st, 2017 along with the congregation’s Delegate Registration Fee. You may pay via the site or with a check payable to the Michigan District Church of the Brethren. New this year, churches pay $50 per allowed delegate (whether or not a church sends all their delegation does not alter the fee) if the registration is received by July 1st. After that day, a late charge of $25 will be due.*Congregation Name*Congregation Contact: Name*Congregation Contact: E-mail*Number of Delegates1234*Delegate 1: NameDelegate 1: AddressDelegate 1: PhoneDelegate 1: Email*Delegate 2: NameDelegate 2: AddressDelegate 2: PhoneDelegate 2: Email*Delegate 3: NameDelegate 3: AddressDelegate 3: PhoneDelegate 3: Email*Delegate 4: NameDelegate 4: AddressDelegate 4: PhoneDelegate 4: EmailDelegation Fee (including $25 for late registration)
