GBSC
Individual
Representation Form

2021 Virtual Mid-Year Session

May 4-5, 2021

Complete the form below online representation form for your church and/or association. If you intended to mail or fax the form, please click here.

Individual Representation Form

Registration Type

Mailing Address *
Mailing Address
Street Address or P.O. Box
Apt/Suite/Office
City
State
Zip/Postal

Representation

Your individual representation fee is $20.00 per person.

Representation Fee *

Representation Fee: $20.00

Contribution to State Missions

In addition to the representation fees above, you are asked to send a contribution for State Missions. The amount to be sent for State Missions is left up to you to decide.

State Missions *

Payment

Subtotal

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