INDIVIDUAL - National Baptist Congress Online Registration [year]

National Baptist Congress Annual Session Registration
Category Individual - $175.00 - 1 Delegate

This form is for registering an Individual Delegate. Please close this window and return to the Convention website to select a different form if you are registering a Church, State Convention or District Association.

Please have your delegate name and first and second choice class selections on hand. If changes or additions are needed after you submit this form for processing, contact the Congress Registration office (see below). Changes cannot be made online after you submit your form.

Congress Registration Office Communication

(Note that we will try to get back to you as soon as possible, but due to high work volumes you should allow up to 48 hours for a response.)

Preferred contact method is email: congressregistration@nationalbaptist.com

Mr. Maurice Lauher, Special Assistant, Registration
P.O. Box 769
Fort Mill, SC 29716
Phone/Fax: 803.396.0805 (call before sending a fax)

(For technical issues with the online registration system,
contact Dr. Denise Mayhan at webmaster@nationalbaptist.com)

* Means required field
Contact Person Information
Contact Name*
Prefix First Name Last Name
Phone Number*
- Area Code 4444444
E-mail*
your receipt will be emailed to this address
Church Information
Church Name*
Pastor Name*
Prefix First Name Last Name

Church Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Church Phone*
- Area Code Phone Number
Church Email
Church Website
My Church's NBC, USA, Inc. Registration Status (select one)*

Registered with the NBC, USA, Inc. Not registered with the NBC, USA, Inc. Don’t know/Not Sure
Congress Online & Mobile Learning Questions

Your answers to the following 3 questions will help us with our planning for Congress online and mobile learning programs
I would like to see the Congress develop online and mobile learning programs and applications

Yes No Not sure
The subject areas and/or types of programs I would like to see the Congress focus on developing are:
The computer and mobile platforms I am interested in are (check all that apply)

PC Mac Android iPhone/iPad Other (list below)
Other Platform(s)
I would like to see more Congress information, networking and learning opportunities on (check all that apply)

Facebook Twitter Website Email Web-based Meetings/Webinars Self-paced self-study programs Other (list below)
Other Method(s):
Registration Materials Mailing Information

If you would like your registration material sent to an address other than the church address (e.g., your home), please enter that address below. *Please note that if you are registering within two weeks of the first day of the Congress, you may have to pick up your registration materials in the Registration Hall at the Convention venue.
Name
Prefix First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Delegate Name and Class Choices
Instructions

Fill in the delegate name (s) and then select first and second class choices by ENTERING THE CLASS NUMBER (not the name).

When you have finished entering your delegates and their class numbers, scroll to the bottom of the page to submit this form and enter your payment information.

Class Availability Look-Up Tables

Click on the links below to look up classes by name or by class number. These documents are updated continuously. Each document will open in a new window for your convenience. You can save time by copying and pasting the class information into the class choice boxes below, or you can also type the information into the box. The Closed Classes List link will open in a new window on the National Baptist website where you can view the current lising of classes that are full and have been closed.

Classes List by Name Classes List by Number Closed Classes List
________________________________
1. Delegate Name*
Prefix First Name Middle Name Last Name
Class 1st Choice - Enter #*
Class 2nd Choice - Enter #*
Registration Category and Payment Information

Individual Registration - $175.00
________________________________________________

BEFORE YOU CLICK: Check to be sure that all of your information is correct. When you click the button "Submit Form and Proceed to Payment" you will be redirected to a secure site to enter your credit card payment information.

Your credit card transaction receipt and detailed registration information will be emailed to you in two separate emails. You may also print this form BEFORE submitting it for payment by selecting "CTRL+P" on your keyboard or clicking the "Print Form" button.
$175.00 - Category Individual (1 Delegate)

Should be Empty:

National Baptist Congress Annual Session Registration

Contact Person Information

Church Information

Congress Online & Mobile Learning Questions

Registration Materials Mailing Information

Delegate Name and Class Choices

Registration Category and Payment Information

$175.00 - Category Individual (1 Delegate)