Summary Report Action Outline SRAO06 Provisional Membership Recommendation Name:
______________________________________________________________________ DCOM Registrar
District:
[__] AP [__] CM [__] NR [__] SS [__] SM [__] TV
Note: On this form you will list all Persons for which a vote is taken and place the date of the vote in the appropriate column. PD = Provisional Deacon PE = Provisional Elder
Name Last
Order First
PD PE
Please submit copies of this form to: [__] DCOM file [__] The Office of Clergy Services via DCOMConcerns@holston.org
Vote: Recommendation to Provisional Membership Recommend Not Recommended Date Date
Updated: 2025-08