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* 1. Church Name

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* 2. Ex-Officio Delegates from the local church
(all assigned ministers, full-time salaried associate ministers, retired assigned ministers and retired missionaries of local churches as provided by the district; the local NMI presidents of the assembly year just ending and newly elected NMI presidents or newly elected vice presidents if the newly elected president cannot attend) NMI Constitution Article VI Section 3 A.3.b

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* 3. NMI Membership (as reported on the APR)

0-37 NMI members = 2 delegates  313-337 = 14  613-637 = 26
 38-62 = 3   338-362 = 15  638-662 = 27
 63-87 = 4   363-387 = 16  663-687 = 28
88-112 = 5   388-412 = 17  688-712 = 29
113-137 = 6   413-437 = 18  713-737 = 30
138-162 = 7   438-462 = 19   738-762 = 31
163-187 = 8  463-487 = 20  763-787 = 32
188-212 = 9   488-512 = 21  788-812 = 33
213-237 = 10   513-537 = 22  813-837 = 34
238-262 = 11   538-562 = 23  838-862 = 35
263-287 = 12  563-587 = 24  863-887 = 36
288-312 = 13  588-612 = 25  888-912 = 37

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* 4. NMI Delegates in order of election
(please include first and last name)
The following delegates have been duly elected to represent our church according to  NMI Constitution Article VI Section 3 A.3.c:

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* 5. NMI Alternate Delegates in order of election
(please include first and last name)
The following delegates have been duly elected to represent our church according to  NMI Constitution Article VI Section 3 A.3.c:

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* 6. Typed Signature
I understand my typed name constitutes a legal signature confirming that I acknowledge and agree to the the validity of information I have provided.

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