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App 04 Print Form Updated: 2020-11
THE UNITED METHODIST CHURCH APPLICATION FOR READMISSION TO CLERGY RELATIONSHIP WITH ANNUAL CONFERENCE Name:
First
Address: Street Cell Phone: (
Middle
Last
City
State
)
Zip
Other Phone: (
E-mail:
Birth Date:
Conference:
District:
)
I hereby request: _
_ Reinstatement as a Local Pastor _ Part-time Local Pastor Full-time Local Pastor _
_
_ Readmission as a Clergy Member of the Annual Conference _ Associate Member _ Provisional Member _ Deacon in Full Connection _ Elder in Full Connection
The status from which I wish to be reinstated or readmitted is: _ _ _ _ _ _ _ _
Discontinued Local Pastor Discontinued Provisional Member Honorable Location Administrative Location Withdrawal to Unite with another Denomination Leaving the Ministerial Office Withdrawal Under Complaints or Charges Involuntary Retirement
Signature:
www.bomlibrary.org Candidacy/Conference Relations Forms, 2017-2020
Date: