2022 Central/Southern Illinois Synod Assembly - Central/Southern Illinois Synod

*First Name *Last Name *E-mail Due to the nature of the online session, each voting memberMUSTprovide their own unique email address (e.g., a couple cannot share an email address).*Mobile Phone Number *Congregation Name *Congregation City Mailing Address City State Zip *ConferenceEast CentralNortheastNorthernNorthwestSouthernWest Central*Registration CategoriesPastor-CalledPastor-RetiredPastor-Specialized MinistryPastor-On LeavePastor-Synod CouncilDeacon-CalledDeacon-RetiredLay Voting MemberLay Voting Member-YouthLay-Synod CouncilVisitorMaleFemaleHearing AssistanceMobility AssistanceVoting Member Registration Fee: $70.00 (non-refundable)Visitor Registration Fee: $65.00 (non-refundable)Late Fee March 2-May 15: $25.00 (non-refundable)Note: If you are registering more than one person, you will need to fill out a separate registration form for each person. You may make one payment (please include the names of all registrants in the memo line of the payment form.)*Enter Your Total Payment Due:I am paying online.I am sending a check to the synod office.If you are paying online, please use the form found by clicking the "Pay Now" button below. After you complete your payment, submit your registration form with red button at the bottom of the page. If you are having difficulties with the payment form, please try a different browser or the form athttps://onrealm.org/CentralSouthern/give/assembly.

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