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Leadership Gathering Member Info Form
Leadership Gathering Member Info
Name
*
Name
First
First
Last
Last
I am a
*
Lay Person
Clergy Person
What pronouns do you use?
He/Him
She/Her
They/Them
Other
Other
Address
*
Address
Address
Address
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
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Delaware
District of Columbia
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Pennsylvania
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South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Email
*
Mobile Phone
*
Parish Name
Parish Town
Have you completed Safe Church training in the last 3 years?
*
Yes
No
Other
Other
Date Safe Church Training Completed
Have you completed anti-racism training in the last 3 years?
*
Yes
No
Other
Other
Date Anti-Racism Training Completed
Do you have any dietary restrictions?
Vegetarian
Vegan
Gluten-Free
Nut Allergy
None
Other
Other
Please upload a photo of yourself for use on ECCT’s Leadership webpage.
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Maximum file size: 268.44MB
Photograph should be a head shot (passport style). Ideally, it should be cropped square, at 300 pixels or more on each side, with a resolution of 300 ppi or more, saved as a .png or .jpg file.
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