2026 DISTRICT CONFERENCE REGISTRATION (registering more than 12 delegates)

2026 DISTRICT CONFERENCE REGISTRATION (registering more than 12 delegates)

District Conference Registration Form

(if registering more than 12 delegates)

Due by May 15, 2026

Use this form to register persons from your church who will attend the

Northeast District Conference at

Bethany Wesleyan Church, 675 Blue Mountain Dr., Cherryville, PA

on June 11-12, 2026.
Church
Listed by City
MINISTERIAL DELEGATES, LAY DELEGATES AND LAY DBA MEMBERS
1. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
2. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
3. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
4. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
5. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
6. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
7. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
8. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
9. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
10. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
11. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
12. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
13. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
14. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
15. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
16. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
17. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
18. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
19. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
20. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
21. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
22. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
23. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
24. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
25. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
26. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
27. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
28. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
29. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
30. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
31. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
32. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
33. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
34. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
35. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
36. Last Name
First Name
Ministerial Delegate, Local Church Lay Delegate or Lay Member of the DBA?
NON-VOTING GUEST CONFERENCE REGISTRATION - $60/person (this covers the cost of Thursday Dinner, the Ordination Reception and Friday Lunch)
1. Last Name
First Name
2. Last Name
First Name
3. Last Name
First Name
4. Last Name
First Name
5. Last Name
First Name
6. Last Name
First Name
7. Last Name
First Name
8. Last Name
First Name
9. Last Name
First Name
10. Last Name
First Name
11. Last Name
First Name
12. Last Name
First Name
All delegates and non-voting guests MUST pre-register!
Enter number of delegates and non-voting guests attending...
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Number of Delegates
Free Quantity

Number of Non-voting Guests
Cost includes Thursday Dinner, Ordination Reception and Friday Lunch

$60.00 Quantity

Total

$0.00
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Payment Methods

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