Mid-Year Session Parent Body Registration

If you prefer, you may download and print this form instead of filling it out online: Downloadable PDF Form

"*" indicates required fields

Step 1 of 2 - Information

Personal Information

Your Name*

First Last

Your Email Address*

Your Phone Number*

Your Address*

Street Address Address Line 2 City State ZIP Code

Church Information

Church Name

Church Pastor Name

Church Email Address

Church Phone Number

Church Address

Street Address Address Line 2 City State ZIP Code

Association Information

Association Name

Moderator Name

Association Phone Number

Association Address

Street Address Address Line 2 City State ZIP Code

Church Affiliations

The Progressive National Baptist Convention, Inc.

National Baptist Convention U.S.A., Inc.

Lott Carey Baptist Foreign Mission

National Baptist Convention of America

National Missionary Baptist

American Baptist

Full Gospel Baptist

Southern Baptist Convention

Registration Fees*

Additional Contributions

Please indicate the amount you wish to donate in the spaces provided.

Mission Contributions

Children's Home of VA Baptist

Evangelism Board

Foreign Mission

Home Mission Board

Educational Contributions

Richmond Virginia Seminary

VUU SDP School of Theology

Virginia University of Lynchburg

Department Contributions

Christian Education

Deacon/Deaconess

Young Pastors & Ministers

Women in Ministry

Ushers

Youth & Young Adult

Checkout

Total

Billing Address

Street Address Address Line 2 City State ZIP Code

Payment Method*

Credit Card

Card Details

Cardholder Name

Please remit payments to:

The Virginia Baptist State Convention, Inc.
50 Moral Hill Dr.
Axton, Virginia 24054

Comments

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