Mid-Year Contact Update – Northern California Nevada Conference

New Mailing Address*

Street Address Address Line 2 City State ZIP Code

New Email Address*

New Phone Number*

Phone Number Type*

Position Title*

Is New Employer/Ministry Setting:*

Name of NCNC-UCC Local Church*

Name of New Employer/Ministry Setting*

Address of New Employer/Ministry Setting*

Street Address Address Line 2 City State ZIP Code

Affiliation of Church*

Have you updated your Ecclesial Covenant?*

I'd like to be considered as an Advisor for a Minister in Discernment.*