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NC Conference of
The United Methodist Church
700 Waterfield Ridge Place
Garner, NC 27529

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Name(Required)

Name of person filling out the form.

First Last

Pastor's Name(Required)

Name of senior pastor.

First Last

Church

District(Required)

Please select the district you are currently located in.

Church Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Email(Required)

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Church Council

List the members of your church council that voted to become a Lighthouse Congregation.

Date

What date did the vote take place?

Notes

Any further notes you would like to mention or questions you may have, feel free to list here.