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 WithPersonal 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 PresidentState Women's PresidentDistrict AssociationDistrict 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 ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name
