Women’s Missionary and Educational Auxiliary

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

Your Name*
First Last
TItle*
Your Email Address*
Your Phone Number*
Your Address*
Street Address Address Line 2 City State ZIP Code
Registration Type*
- ($25) Individual Registration
- ($50) Missionary Circle or Society
- ($100) Association
- ($75) Individual Registration + Missionary Circle
- ($125) Individual Registration + Association
- ($150) Missionary Circle or Society + Association
- ($175) All Registrations
Individual Registration
Church Affiliation*
Church Address*
Street Address Address Line 2 City State ZIP Code
Pastor*
Association*
Missionary Circle or Society Registration/Association Registration
Church Circle
Church President
Church Email Address
Church Phone Number
President's Address
Street Address Address Line 2 City State ZIP Code
Pastor*
Association*
Checkout
Total
$0.00
Payment Method
Credit Card*
Card Details
Cardholder Name
Please remit payments to:

The Virginia Baptist State Convention, Inc.
22 East Church Street, Suite 208
Martinsville, Virginia 24112
Comments
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Individual Registration