Delegate Pre-Registration

National Baptist Laymen’s Movement

National Baptist Convention, USA, Inc. Dr. Jerry Young, President Dr. Calvin McKinney, General Secretary

Annual Session Finance Committee Use OnlyState ID Number: ___________________________

State Convention ID Number: ________________Association ID Number: _____________________ Church ID Number: _______________________

Name:

Address:

City:

State:

Zip:

Telephone:

Fax:

EmailAdddress:

Birthday:

Church Name:

Address:

City: State: Zip:

Pastor:

Name of Yout State Convention:

Your State Laymen President:

Name of Your District:

Your District Laymen President:

Your Local Laymen President:

REGISTRATION JANUARY JUNE SEPTEMBER CODE AMOUNT Laymen Delegate 40.00 30.00 (007017)

National Baptist Laymen Leaders 100.00 55.00 35.00 (007003)

State Laymen Auxiliary 35.00 35.00 65.00 (007004) District Laymen Auxiliary 30.00 30.00 50.00 (007005)

Local Church Laymen Auxiliary 25.00 25.00 40.00 (007006)

Additional Registration Fee/June only 25.00 (007021)

SPECIALPROJECTS AMOUNT Special Project Breakfast Donation (007007)

State President Report (007008) Senior Laymen Allen Jordan Seminar 40.00 (007010) Junior Laymen Allen Jordan Seminar 35.00 (007011)

Allen Jordan Seminar Fee-Non-attender 20.00 (007012) Mission & Education & Evangelism (007013) Miss & Edu & Evangelism Luncheon Ticket (007014)

LW & Supporters Prayer Breakfast (007018)

Royal Court Donations (007019)

John L. Webb Banquet Tickets (007020) DISCIPLESHIPS Senior Laymen Discipleship 40.00 (007001) Junior Laymen Discipleship 25.00 (007002)

TOTALS

METHODS OF PAYMENT _____ Cash – Onsite Only(DO NOT MAIL CASH)

_____ Check – Check # ___________Payable To: National Baptist Convention USA, Inc.

Received by: _________________________________________ Date Received: _____________________________________________________

PLEASE RETURN THIS FORM AND FEES:Registration Office Baptist World Center • 1700 Baptist World Center Drive • Nashville, TN 37207

(White-Registration/Finance, Yellow-Auxiliary, Pink-Delegate)