ASSOCIATION INFORMATION UPDATE

Association Information Update

Thank you to your Association for completing this form. In doing so, you ensure that the Convention has the latest
information regarding your church. Once completed, you may mail this form to the Baptist Headquarters (125 E South Street, Raleigh, NC 27601) or
email to Dr Tony Barr (t.barr@gbsconline.org).

Today's Date

Association Association

Association Physical Address (This May Be Different From the Mailing Address)

City

State/Province

Zip/Postal

Association Website

Association Email

Do You Want Convention Event Updates?

Association Mailing Address

City

State/Province

Zip/Postal

Moderator Information

Name

First

Last

Address

City

State/Province

Zip/Postal

Country

Phone

Do You Want Convention Event Updates?

Is There A Vice-Moderator?

Vice-Moderator Information

Vice-Moderator-At-Large

Vice-Moderator-At-Large
First
First
Last
Last

Address

Address
Address
Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Country

Phone

Email

Do You Want Convention Event Updates?

Is There A 1st Vice-Moderator?

1st Vice-Moderator Information

1st Vice-Moderator

1st Vice-Moderator
First
First
Last
Last

Address

Address
Address
Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Country

Phone

Email

Do You Want Convention Event Updates?

Is There a 2nd Vice-Moderator?

2nd Vice-Moderator Information

2nd Vice-Moderator

2nd Vice-Moderator
First
First
Last
Last

Address

Address
Address
Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Country

Phone

Email

Do You Want Convention Event Updates?

Is There a 3rd Vice-Moderator?

3rd Vice-Moderator Information

3rd Vice-Moderator

3rd Vice-Moderator
First
First
Last
Last

Address

Address
Address
Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Country

Phone

Email

Do You Want Convention Event Updates?

Is There a 4th Vice-Moderator?

4th Vice-Moderator Information

4th Vice-Moderator

4th Vice-Moderator
First
First
Last
Last

Address

Address
Address
Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Country

Phone

Email

Do You Want Convention Event Updates?

Moderator Information

Vice-Moderator Information

1st Vice-Moderator Information

2nd Vice-Moderator Information

3rd Vice-Moderator Information

4th Vice-Moderator Information

Our Organization

Explore

Contact Info

REGISTER TODAY FOR OUR 2023 MID-YEAR SESSION!

REGISTRATION DEADLINE: APRIL 20, 2023