Regular Arkansas Baptist Convention, Inc.

P.O. Box 2736

Pine Bluff, Arkansas 71613

Official Registration and Receipt

Date ______

Convention Session ______

Meeting Location (Church & City) ______

Church or District Name ______

Address ______City ______Zip ______

Phone ______Fax ______Email ______

Pastor ______Number of Members ______

Person Making Report & Position ______

Is the Church Represented by the Unified Budget? _____ Yes _____ No

Delegate’s Name(s):

List no more than ten (10) including the pastor

______

______

______

______

Code / Category / Amount
Total Amount Paid

Registration Categories (Please list the registration categories from the list below)

Code / Category
100 / Church
101 / District Association
102 / Convention Trustee/Board Member
103 / State Officer
104 / Pastor
105 / Minister, not pastor
200 / State Woman’s Officer
201 / State Woman’s Ministry Leader
202 / State Woman’s Ministry Member
203 / Woman’s Banquet/Retreat
204 / Ministers’ Wives & Widow
205 / Deacons’ Wives & Widow
206 / Woman’s Foreign Mission
207 / Woman’s Special Projects/Workshop
208 / Green Tea/Founders’ Day
209 / Woman’s Personal Registration
210 / District Woman’s Auxiliary
211 / District Woman’s Auxiliary President
212 / Church Missionary Society
213 / Church WMS President
214 / Young People’s Department
215 / Young People Officer
300 / Congress of Christian Education
400 / Home & Foreign Mission Convention
500 / Music Convention
600 / Evangelism Department
700 / Ushers’ Convention
800 / Laymen’s Department
900 / Morris Booker College
1000 / Other (Explain)

Cash ___ Check/Money Order# ______

Rec’d by: ______

Original to Registrant – Copy 1 to file – Copy 2 to Credentials