2024 Convention Delegate Form

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1. Fill in all blanks on the form that are applicable.
2. Each church is entitled to one (1) vote for each twenty-five (25), or fraction thereof, of its eligible number of voters in the local congregation. This should not be the number in your Sunday School attendance or enrollment. (Example: 1-25 eligible voters — 1 vote; 26-50 eligible voters — 2 votes, etc.)
3. Names of ordained and licensed ministers of the Church of God (Holiness) who desire a vote in the General Convention and who are not listed as delegates from local churches should be listed on the form for Churches. This may include the pastor of each local church. Ministers who will not be listed on the form for Churches should complete the form for Ministers.
4. Forms must be submitted by May 31, 2024. Any person or church submitting a form after this deadline may be required to wait until the afternoon session of the Convention to be seated as a delegate.
5. The Convention recommends to the churches that they select their delegates on the basis of holy living.

Date *

YYYY

Name of Church *

Church Physical Address *

Name of Delegate 1

Name of Delegate 2

Name of Delegate 3

Name of Delegate 4

Name of Delegate 5

Name(s) of Alternate Delegate(s)

Total Number of Delegate Votes *

Email Address *

Do you wish to receive electronic copies of the departments’ financial statements to review before Convention? *

Yes

List the names of ordained or licensed ministers who desire a seat in the Convention and are not otherwise named as delegates.

Total Number of Minister Votes *

The required fee for each vote (delegate or minister) is $20.00. Please enter the total fee amount required for all of the votes you are requesting. *

How would you like to pay the fee for your Convention votes? *

I will mail a check to Convention Roll Committee, 7401 Metcalf Ave., Overland Park, KS 66204.

Please send me an electronic invoice so I can pay using a credit/debit card.

I will bring my payment (cash, check, or credit/debit card) with me to Convention.

Name of Church Chairman *

Name of Church Secretary

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