National Baptist Convention Event Registration

Mid Winter Board Meeting Registration - USHERS & NURSES

Mr. James McHenry, President
We accept MasterCard, Visa and Discover Cards

Instructions

This form is for registering for the USHERS AND NURSES 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
Ushers and Nurses Auxiliary Delegate Information
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
First Time Attendee?
Number of Years Attended
Personal ID Number
Additional Delegate Contact Information (name, address, email, phone)
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 E-mail
Church Website
State Convention Information
What is your State Convention's name? (select)
Enter State Convention name if not listed:
State Ushers President Name
State Nurses President 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
State Ushers (5001) $100.00 USD
State Nurses (5002) $100.00 USD
District Ushers (5003) $80.00 USD
District Nurses (5004) $80.00 USD
Church Ushers (5005) $50.00 USD
Church Nurses (5006) $50.00 USD
National President (5007) $100.00 USD
National Vice President (5008) $100.00 USD
National Elected Officers (5009) $75.00 USD
National Chairpersons/Co-Chairpersons (5010) $40.00 USD
Personal Enrollment (5011) $40.00 USD
Donations - $5 increments $5.00 USD

Quantity Category
Donations - $10 increments $10.00 USD

$10 X Category
Donations - $25 increments $25.00 USD

$25 X Category
Donations - $100 increments $100.00 USD

Quantity Category

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 - USHERS & NURSES

Ushers and Nurses Auxiliary Delegate Information

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

Church Information

State Convention Information

Notes

Payments