Synod Registration Form

About You

Full Name *

Email Address *

Phone *

Church Name & Location (City, State) *

Emergency Contact Information (Name and Phone Number) *

Attending Synod as: *ClergyLay DeputyAlternate Lay DeputyStaffGuest

Are You A Clergy Spouse?NoYes

Dietary Restrictions

Dietary Restrictions *NoneVegetarianVeganKosherGluten-freeOther Allergies (listed below)

Food and/or Drink AllergiesList food and/or drink allergies we need to be aware of.

Display Tables

Do You Need to Reserve Display Tables?If yes, indicate how manyNoOne TableTwo TablesThree Tables

The ministry, group, or purpose for your display table(s) *

Event Registration & Payment

Event Options *Full Synod - $310Thursday Dinner ONLY - $60Friday Banquet ONLY - $60Thursday Dinner & Friday Banquet ONLY - $120Clergy Spouse Luncheon ONLY - $30

Do you plan to attend the Clergy Spouse Luncheon (Friday at 11am)?The Clergy Spouse Luncheon is free for full synod attendeesYes

Payment Method *How do you want to pay? (Online payments will include a process fee of 2.9% + $0.30.)Debit/Credit Card Online (Secure)Mail a Check

Any Additional Comments?

Registration Total

$

Online Registration Total

$

Payment by Check Instructions

To complete your registration payment by check, write your check for the amount displayed in the Registration Total field above. Make your check payable to "Diocese of Quincy", then write "SYNOD" in the memo line.

Mail it to:
Diocese of Quincy
Attn: Synod
4911 N. Knoxville Ave.
Peoria, IL 61614-4913

Your registration will not be complete until payment is received. Thank you.

Credit / Debit Card (Secured through Stripe) *

Please do not fill in this field.

4911 N. Knoxville Ave.
Peoria, IL 61614

+1 (309) 688-8221

doq@dioceseofquincy.org