Servant Event Host Application Form

Instructions

• Use this form to register as a LCMS Servant Event Host.
• Enter all information on the form. Required fields are marked with a * and will be included in the Servant Event information that is viewed on the Web site.
• When you have finished entering all of the information, click on the "Send Application" button. This will store your information into the "Hosts" database.
• After review and approval, your servant event will be "live" on the Servant Events Web site.

* Hosting Entity Name:

(Host may be a congregation, outdoor ministry center, social ministry agency, etc.)

* Address:

* City: * State: Select your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * ZIP:

* LCMS District:   select a district Atlantic Calif/Nevada/Hawaii Central Illinois Eastern English Florida-Georgia Indiana Iowa East Iowa West Kansas Michigan Mid-South Minnesota North Minnesota South Missouri Montana Nebraska New England New Jersey North Dakota North Wisconsin Northern Illinois Northwest Ohio Oklahoma Pacific Southwest Rocky Mountain SELC South Dakota South Wisconsin Southeastern Southern Southern Illinois Texas Wyoming Intl.-Partner Church

Country: (Only if NOT in the United States)

* Phone #: FAX #:

* E-mail Address:

Web Address:

* Contact Person: Title: Title Mr Rev Dr Mrs Miss Ms * First Name:

* M.I.: * Last Name: Suffix:

Assign yourself a username and password, these will be used to re-enter the site to edit your host information, submit new Servant Events or edit existing ones. Please, write these down and keep them in a safe place. No spaces in Username or Password Please.

* Username: * Password:

Please carefully check over your entries and when satisfied they are correct, click on the "Send Application" button only once!

NOTE: Depending on the speed of your Internet connection, it may take from a few seconds to a minute or more for this form to be processed by our server. When the server is finished processing your information you will be taken to the next page.