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Metropolitan New York Synod Evangelical Lutheran Church in America The Lutheran Center - 475 Riverside Drive, 16th floor New York City, NY 10115

Phone (212) 665 - 0732 www.metronysynod.com

Application for Admission to the Synodical Diaconate At the end of each page, click "Next" - there are 5 pages to print out.

	Date Application Completed_______________________________________________________
	Full Name______________________________________________________________________
	Home Address__________________________________________________________________
	Home Phone___________________________________________________________________
	Business Name and Address
	Business Phone_________________________________________________________________
	Date and Place of birth____________________________________________________________
	US Citizen?_______________ if not, list citizenship____________________________________
	Member of_________________________________ Lutheran Church since_______________
	Church Address_________________________________________________________________
	Pastor (s)______________________________________________________________________
	If a member fewer than 5 years, list prior Church membership and length of membership

Please list offices held and functions performed in local congregation,
with approximate time frames:>

Function	From	Until