Name:


Address:


City:                          State:                            ZIP Code            
       

Home phone:            Office phone:
    

E-mail address


Congregation name/city:

First name as you would like it to appear on name tag:
      

I learned about this event from:

Pastor
Synod Web page
Congregation member
Sunday bulletin insert
Teacher
Friend
Other: (please describe)



There is no cost associated with attending this event.

Thank  you.

Please print out this form before e-mailing it to save for your records.         

(Submit sends an e-mail with your information to the Metropolitan Chicago Synod, ELCA)

Questions about the form? 
Contact Jeff Drake in the synod office at jdrake@mcselca.org or call 773-248-0021.