Woman’s Auxiliary Delegate Pre-Registration Step 1 of 3 - Contact Information 33% Name First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Convening With Personal ID Number* First Time Attendee?*YesNoHow Many Years Have You Attended? State Convention* President* Church Name* Church Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Pastor* Local Women's President State Women's President District Association District Women's President National Officer (8001) Price: $200.00 Quantity: National Chairperson (8002) Price: $100.00 Quantity: National Co-Chairperson (8003) Price: $100.00 Quantity: State President (8004) Price: $75.00 Quantity: District President (8005) Price: $50.00 Quantity: Local Women's President (8006) Price: $25.00 Quantity: Delegate (8007) Price: $25.00 Quantity: New President (8008) Price: $25.00 Quantity: Local Missionary Society (8009) Price: $100.00 Quantity: State Convention (8010) Price: $200.00 Quantity: District Women's Auxiliary (8011) Price: $175.00 Quantity: Ministers' Wives (8013) Price: $25.00 Quantity: Deacons' Wives (8014) Price: $25.00 Quantity: National Baptist Woman Journal (8019) Price: $13.00 Quantity: Donations Please use the spaces below to contribute to missions of your choosing.Foreign Mission (8015) Home Mission (8016) American Baptist College (8018) Women in White March (8030) Arkansas Baptist College (8022) Women's Auxiliary Health Committee (8023) National Baptist World Day of Prayer - May (8017) World Day of Prayer - November (8031) Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name
