Women’s Auxiliary Registration

Connecticut State Missionary Baptist Convention
Reverend Dr. Boise Kimber, President

Complete this form to register for the women’s auxiliary, or you may print and return the registration form (PDF) by mail or fax if you prefer.

Your Name*
Your Email*
Ministry Name*
Church Name*
Church Address*
Street Address Address Line 2 City State ZIP Code
Church Phone Number*
Pastor's Name*
Missionary President*
Missionary President Phone Number*
Moderator*
District President*
Association
Registrations
Senior Missionaries (per church)*
Price:
Women's District Association Fee*
Price:
Number of Delegates*
Delegate Names and Ministries*
One delegate per line, in this format: Name / Ministry
Total
$0.00
Payment Method
Make Checks Payable To:

CSMBC-WA

Deacon Naomi Knox 10 Fountain Ter.
New Haven, CT 06515

If you have any questions, please contact us at 203.838.5715.
Please call us to make payment arrangements at 203.838.5715
Billing Address*
Street Address Address Line 2 City State ZIP Code
Credit Card
Card Details
Cardholder Name
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Comments
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