Missions Banquet Registration Form
William Carey University
BSU Missions Banquet

featuring speaker Pam Shearer
(former missionary to Peru)


March 22, 2013
The Refuge at Temple Baptist Church
5220 Old Hwy 11
Hattiesburg, MS 39402

6:30 pm
Meal provided
Donations will be accepted

Complete the form below to register for the
2013 William Carey University Missions Banquet.


All fields in red are required to submit this form.

Personal Information

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  First Name: 
Preferred Name: 

  Last Name: 
 
 


Address Information

  Address 1: 
Address 2: 

  City: 
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  Zip Code: 
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Email Information

  Email: 
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Seating Information

  Number of Seats: 


Please choose one of the following (Optional):
Make a donation per seat.

Donation Opportunities

If you are unable to attend the banquet or
you would like to donate additional funds to summer missions,
please indicate a donation amount below:

  Donation Amount: $


All donations are tax-deductible.

100% of all donations for go to support William Carey University BSU Summer Missions.

For more information, contact Lauran Burnham in the Baptist Student Union
by email at lburnham@wmcarey.edu or by phone at 601-318-6161.