171st session of the California-Nevada Annual Conference | June 19-22, 2019 | Modesto, CA

ACS19: Annual Conference Registration

June 19-22, 2019

Double Tree Hotel
1150 9th Street
Modesto, CA 95354

Registration Deadline: June 1, 2019

If you need assistance with registration, please email Conference Registrar, at acsregistrar@calnevumc.org.

* indicates required field.

Contact Info:

Please enter the name and email of person filling out this form. A valid email is required to received a confirmation notice.

*First Name
*Last Name
*Email
*Select your conference leadership status:
REGISTRANT INFORMATION

Names are sorted alphabetically by last name. If your name is misspelled, please contact the conference registrar to make corrections.

CLERGY
*My clergy status is:
Deacon in Full Connection:

(select your name from the list)

*Elder in Full Connection:

(select your name from the list)

Retired Elder:

(select your name from the list)

Retired Associate Member:

(select your name from the list)

Retired Deacon:

(select your name from the list)

Full-Time/Part-Time Local Pastor:

(select your name from the list)

Retired Local Pastor:

(select your name from the list)

Provisional Elder:

(select your name from the list)

Provisional Deacon:

(select your name from the list)

Elder Member of other Conference or Methodist Denomination:

(select your name from the list)

Retired Member of other Conference:

(select your name from the list)

Other Non-Methodist Denomination

(select your name from the list)

Will your spouse be attending?
Yes
No
No answer
Name of spouse:

If spouse is also a clergy member, they will need to register separately. If not applicable, enter N/A.

LAITY
*My laity status is:
Lay Member to ACS:

(select your name from the list)

Alternate Lay Member:

(select your name from the list)

Certified Lay Minister:

(select your name from the list)

*Certified Candidate for Ordained Ministry:

(select your name from the list)

*Date you became certified:
*Lay Member by Virtue of Office:

(select the name of your office/committee from the list)

Enter first and last name:
Role:
Conference Officer:

(select your name from the list)

Conference Staff:
Cell Phone:

If you don't have a cell phone number, please indicate the best number where you can be reached.

District:

If you are not affiliated with a California-Nevada district, select 'N/A'.

SPECIAL NEEDS
*Do you have special needs you want us to consider?
Yes
No
If yes, please explain.
*Do you have a disability (ie. visual, auditory, or physical) that requires special seating?

Members with disabilities who need special reserved seating are the only members who will have reserved seats.  For example, in front of the monitors or easy access for a wheelchair.  All others may choose their seats on arrival.

Yes
No
Indicate your seating preference:
DEMOGRAPHIC INFO
*Gender
Female
Male
Racial Identity

Please select all that apply.

A - Asian
AA - African American/Black
H/L - Hispanic/Latina(o)
W - White
NA - Native American
PI - Pacific Islander
Other
If you selected other, please specify.
Ethnic Background

Please select all that apply.

Chinese
Filipino
Hmong
Japanese
Korean
Chamorro
Fijian
Samoan
Tongan
Other
If you selected other, please specify.
Questions/Concerns?

Contact the conference registrar by email at acsregistrar@calnevumc.org.

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