Church Name:  * Year-end Church Membership  * Southern California District Assembly Date:  * Ex Officio Delegates (Members of the district assembly by virtue of office for the new assembly year) According to Manual 201 department heads (or their Vice) elected to serve in the new church year represent your church at the District Assembly not the officers during the past year. NMI President NMI Vice President NYI President NYI Vice President SSM Supt. SSM Vice Supt. Additional Delegates Members 0-75 = 1 DelegateMembers 76-125 = 2 DelegateMembers 126-175 = 3 DelegateMembers 176-225= 4 DelegateMembers 226-275 = 5 DelegateMembers 276-325 = 6 DelegateMembers 326-375 = 7 DelegateMembers 376-425 = 8 DelegateMembers 426-475 = 9 DelegateMembers 476-525 = 10 DelegateMembers 526-575 = 11 DelegateMembers 576-625 = 12 Delegate if your church is eligilbe for more than 12 or 13 delegated continue the appropriate chart to reach the total number of delegates allowed for your church membership. If the church is a Church-Type Mission which has members the Board of General Superintendents issued a ruling in 1998 that the pastor may name the eligible delegates based on the appropriate chart above. The following lay delegated have been duly elected to represent our church at the District Assembly according to Manual 201.1 or 201.2 Please enter Lay Delegates Lay Delegate #1 Lay Delegate #2 Lay Delegate #3 Lay Delegate #4 Lay Delegate #5 Lay Delegate #6 Lay Delegate #7 Lay Delegate #8 Lay Delegate #9 Lay Delegate #10 Lay Delegate #11 Lay Delegate #12 Please enter Alternate Lay Delegates Alternate Lay Delegate #1 Alternate Lay Delegate #2 Alternate Lay Delegate #3 Alternate Lay Delegate #4 Alternate Lay Delegate #5 Alternate Lay Delegate #6 Alternate Lay Delegate #7 Alternate Lay Delegate #8 Alternate Lay Delegate #9 Alternate Lay Delegate #10 Alternate Lay Delegate #11 Alternate Lay Delegate #12   Please initial below to verify all information is correct. Initials  * Do not enter anything in this field:

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