National Baptist Convention Event Registration

Mid Winter Board Meeting Registration - LAYMEN

Mr. Harold L. Simmons, President
We accept MasterCard, Visa and Discover Cards

Instructions

This form is for registering for the LAYMEN for the Mid-Winter Board Meeting of the National Baptist Convention, USA, Inc. If you want to register for a different Auxiliary or the Parent Body, please go back to the website and choose the correct form. Each form must be submitted separately.

Please review the printed forms and have all your information handy. Changes cannot be made online after you submit your form. You will need to make changes at the Registration Desk.

For technical issues with the online registration system, contact Dr. Denise Mayhan at webmanager@nationalbaptist.com.

* Means required field
Layman's Information

(Layman's contact information. This person will also receive receipts and respond to questions, if any)
Name*
Prefix First Name Middle Name Last Name Suffix

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail*
your receipt will be emailed to this address
Phone Number*
- Area Code 4444444
Fax Number
- Area Code 4444444
Birth Date
Month Day Year
Get Connected! Enter your email address to receive NBC, USA, Inc. Email Newsletters:
(about 6 times per year)
Church Information
Church Name
Pastor Name
Prefix First Name Last Name

Church Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Church Website
State/District/Local Laymen Information
District Laymen President's Name
Name of Your District?
What is your State Convention's name? (select)
Enter State Convention name if not listed:
State Laymen President's Name
Local Laymen President's Name
________________________________
Notes
Enter additional information in this text box:
________________________________
Payments

Check the boxes desired for the registration categories, event tickets and donations. Select the quantity or type of donation. Your total will be calculated and shown at the end of the page.
Registration, Tickets & Donations Categories & Fees
National Baptist Laymen Leaders (Code 7003) $100.00 USD
State Laymen Auxiliary (Code 7004) $35.00 USD
District Laymen Auxiliary (Code 7005) $30.00 USD
Local Church Laymen Auxiliary (Code 7006) $25.00 USD
Senior Layman Discipleship (Code #7001) $40.00 USD

Quantity
Junior Laymen Discipleship (Code #7002) $25.00 USD

Quantity
Other Donations (Code 7021) - $10 increments $10.00 USD

$10 X
Other Donations (Code 7021) - $25 increments $25.00 USD

$25 X
Other Donations (Code 7021) - $100 increments $100.00 USD

$100 x

Total: $0.00 USD
________________________________________________

BEFORE YOU CLICK: Check to be sure that all of your information is correct. When you click the "Submit Form" button you will be redirected to a secure site to enter your credit card payment information.

Your credit card transaction receipt and detailed registration information will be emailed to you in two separate emails.
Should be Empty:

Mid Winter Board Meeting Registration - LAYMEN

Layman's Information

Get Connected! Enter your email address to receive NBC, USA, Inc. Email Newsletters:

Church Information

State/District/Local Laymen Information

Notes

Payments