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Badges and credentials will be made using this information. Please enter complete information, verified and correctly spelled. Totals calculated and shown below should match the totals on the back of your Annual Church Report. Forms are available electronically at www.nblchurch.org. With minimal input (Title, First Name, and Last Name), this form will anticipate remaining information, and calculate totals. You may override the guessed information by manually typing over it.

If you are using a computer to complete this form, move your mouse over the right-top-corner of each column heading for a column explanation.
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Church Name:City, State:
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Pastor's Name: Total for Your Church Check:$0.00
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Pastor's Signature:___________________________________________________ (I have reviewed and approve the information entered in this form)
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#Church TitleFirst NameLast NameSaved?Over 15 Years Old?Organization Membership
Dues Given		Fellowship Card Needed?Credential
Certificate Needed?		Are They Coming to the Convocation?
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