Registration Form - 76th Southern District Convention

Convention Registration Form

76th Convention of the LCMS Southern District
Please note: Everyone attending the convention must submit a registration form. If your spouse or another guest will attend the convention with you, please submit a separate registration form. The deadline to register is February 21, 2022.

Please use Sentence Case when entering names: John, Mary, Airport Drive, Slidell (not lowercase or UPPERCASE: john/JOHN, mary/MARY, airport drive/AIRPORT DRIVE, slidell/SLIDELL).

Registration questions may be directed to Mrs. Daisy Olmstead (d.olmstead@southernlcms.org or 985-635-4382).
Title *
First Name *
Last Name *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *
Email *
example@example.com
What type of attendee are you registering as? *
Congregation / School / Organization You are Representing *
Congregation / School / Organization City *
Congregation / School / Organization State *
Congregation / School / Organization ZIP *
Circuit Number (if you are representing a congregation)
Name of Emergency Contact Person *

First Name Last Name
Contact's Relationship to You *
Emergency Contact Phone Number *

Voting Delegate Registration - Accreditation Form - REQUIRED
All voting delegates must be accredited (provide proper credentials). The accreditation form ("2022 District Convention Voting Delegate Registration Form") and instructions are available here. Information and the accreditation form are also available on the convention page of the Southern District website.

PLEASE READ CAREFULLY: I understand that as a voting delegate to the Southern District Convention, my registration is not complete and I am not eligible to vote until the accreditation form is completed, signed by two officers, and submitted in advance or presented to the District Secretary at the opening of the convention. Submission instructions are on the form and the Southern District website.
I have read and understand the voting delegate statement above. *

Yes

Multi-Congregation Parish Congregational Advisory Delegate Registration - Accreditation Form - REQUIRED
All multi-congregation parish congregational advisory delegates must be accredited (provide proper credentials). The accreditation form ("2022 District Convention Multi-Congregation Parish Congregational Advisory Delegate Registration Form") and instructions are available here. Information and the accreditation form are also available on the convention page of the Southern District website.

STATEMENT - PLEASE READ CAREFULLY: I understand that as a multi-congregation parish congregational advisory delegate to the Southern District Convention, my registration is not complete until the accreditation form is completed, signed by two officers, and submitted in advance or presented to the District Secretary at the opening of the convention. Submission instructions are on the form and the Southern District website.
I have read and understand the multi-congregation parish advisory delegate statement above. *

Yes

Exhibitor Information

Exhibitor questions may be directed to Mrs. Janice Howard (j.howard@southernlcms.org or 985-605-5403).
Person Responsible for Display (if different than attendee)

First Name Last Name
Email - Person Responsible for Display (if different than attendee)
example@example.com
Phone Number - Person Responsible for Display (if different than attendee)
Number of 3' x 8' Tables Requested ($100.00 each) *
Number of Electrical Outlets Needed *
Any special display information?

0/200

Presenter Information - AV Needs

Presenter questions may be directed to Mrs. Daisy Olmstead (d.olmstead@southernlcms.org or 985-635-4382).
Computer Presentation *
(Presenters, please select "Yes" or "No." Dignitaries who are not presenters, please select "N/A.")
If yes, what type?

PowerPoint Keynote Prezi Other
Embedded Presentation Video *
(Presenters, please select "Yes" or "No." Dignitaries who are not presenters, please select "N/A.")
Video Playback *
(Presenters, please select "Yes" or "No." Dignitaries who are not presenters, please select "N/A.")
If yes, what type?

DVD Video File Video Link (i.e. YouTube, Vimeo, etc.)
Computer Presentation Audio *
(Presenters, please select "Yes" or "No." Dignitaries who are not presenters, please select "N/A.")
Speaking Preference *
(Presenters, please select "Yes" or "No." Dignitaries who are not presenters, please select "N/A.")
Any special information for the AV Team?

0/200
Speaker Convenience Items Available

For your convenience, the following items will also be available:
- Speaker Timer
- Remote Slide Advance
- Laser pointer

There will be a show computer available for use and is the preferred method of presenting during the convention. It is encouraged that you bring your presentation/video on a USB portable thumb drive. A show AV technician will be able to assist you with loading and testing your presentation prior to your time slot. If you are playing a video or DVD please make it available to the show AV technician as soon as possible or at least 2 hours prior to being presented, for proper testing.

For your convenience, you may upload your presentation/video in advance to the Southern District Convention MediaFire folder at the link below. (If the link does not work by clicking on it, copy and paste the entire link into your browser.)

http://www.mediafire.com/filedrop/filedrop_hosted.php?drop=447da4ca20ed7f865a442193c7817f01b31ef0ec83462706b87fe90383c9f076

Please make sure your file has your name in the file name for easy access. If you have any questions, please contact the Southern District Office.

Board of Directors Lodging Information

If you are on the Board of Directors and attending as a BOD representative (not representing your congregation as a voting delegate), please indicate below whether you will need lodging for the convention. Southern District staff will take care of your accommodations. Lodging questions may be directed to Ms. Ronnie Giaise (r.giaise@southernlcms.org or 985-605-5404). If you are representing your congregation as a voting delegate, you should make your own hotel reservation, and your congregation should cover the expense.
Do you need lodging during the convention? *

Yes No
If yes, please select the nights you will need lodging.

Sunday, March 20, 2022 Monday, March 21, 2022 Tuesday, March 22, 2022

Final Step - Submit Your Form!

Please submit your registration form by clicking the green button below. A copy of your responses will be sent to the email address you provided.

Our staff looks forward to welcoming you to the 76th Southern District Convention!
Date and Time (automatic)

Month Day Year
Date
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Convention Registration Form

Voting Delegate Registration - Accreditation Form - REQUIRED

Multi-Congregation Parish Congregational Advisory Delegate Registration - Accreditation Form - REQUIRED

Exhibitor Information

Presenter Information - AV Needs

Board of Directors Lodging Information