Western Union Baptist Association
Rev., Dr. Marcus Brown, Moderator
Online Registration Form

Mail payments to  W.U.B.D.A. (P.O. Box 60118 Dayton, OH 45406-0118)

Please fill all applicable fields.

Please provide the following information:

Church Name                                         
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Church Phone
FAX
E-mail
URL

Please provide the Pastor's information:

Name                                                      
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
Cell Phone
FAX
E-mail

Please provide the following contact information: (correspondences will be sent to the church).

Your Name                                             
Title
Phone
Cell Phone
FAX
E-mail

Each Registered church allowed two voting members.
Additional voters, $5.00 fee per person (Maximum total of Five Voters).

Amount                                                     Voter's Name (s)

Registration amount will cover all auxiliaries: 5- 50 Members     $  50.00
                                                                                 51-200 Members     $100.00
                                                                                 201 Members Plus $200.00

                                                                   Amount to be Paid
Mail payments toP.O. Box 60118 Dayton, OH 45406-01186

Author information goes here.
Copyright 2009 [Western Union Baptist District Association]. All rights reserved.
Revised: 07/6/2019