2017 Convention Nomination Form

NOMINATION FORM FOR ALL OFFICES ‐ CONVENTION 2017
Episcopal Diocese of Vermont

Please note: All Nominees are encouraged to attend Convention and all those present will be introduced on Saturday Morning, November 4th.

Nominee's Full Name*

PrefixFirst NameLast Name

Elected by Diocesan Convention

Bishop's Appointees

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

Congregation/ Town

Town/ Other

E-mail

Place of Employment (If Applicable)

Nominated By

SelfAnother

Nominator's Full Name

Church/ Town of Nominator

Please List Any Any Current Parochial and/or Diocesan Positions:

Please List Any Previous Parochial and/or Diocesan Positions (Include Approximates Dates)

I Feel Qualified To Serve In This Position Because:

Please Indicate Views On Any Issues That May Be Relevant To This Position:

Briefly Describe Other Interests And Concerns:

I Understand That a Portion of This Information May Appear in The Diocesan E-News*

Yes

I Understand That by Completing this Form That I am Agreeing that I am Willing to be Elected and to Serve*

Yes