Local Church Moderator Affirmation – Northern California Nevada Conference

Church & MID Candidate Details

Please provide information about your Local Church, the Member in Discernment candidate, and about the person completing this form

NCNC-UCC Local Church*

Name of Member in Discernment*

First Last

Your Name*

First Last

Your Role in Local Church*

Your Email Address*

Affirmation for Member in Discernment

Please provide information about your church's support of this Member in Discernment

Describe the process used to affirm this Member in Discernment's application to Committee on Ministry, Section A*

How does your Local Church plan to continue to support this Member in Discernment's journey?*

Affirmation of Support*

I am an authorized representative of this Local Church and can confirm that the leadership of our congregation has formally affirmed this Member in Discernment's application to Committee on Ministry, Section A, to be received as a Member in Discernment on behalf of the United Church of Christ.

I do so affirm.

Signature*