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Make plans now to attend our annual 
National Church Planters Baptist Preservation Camp Meeting 
June 10-14 2012

Camp Meeting Delegate Profile &

Registration Form

If you are planning to attend our camp meeting, please fill out and submit the following form.

Please fill out the following form to submit as your camp meeting delegate profile. We will contact you if we need more information. Limited housing is available to those in full-time ministry (If you are a pastor, evangelist or missionary and are planning on us providing housing for you, please understand that we have limited housing available. We must receive your delegate profile registration no later than May 31, 2012. The Limited Housing is on a first come first serve basis.) Non-ministry participants will be sent a list of economical lodging in the area after recieving your delegate profile. * denotes fields that can not be left blank. NOTE: The anti-spam security at the bottom is case sensitive.

Church You Attend
Your Name*
Address*
City*
State*
ZIP*
Phone*
Email*
Arival Date*
Departure Date*
Are you a full time...*	PASTORMISSIONARYEVANGELIST NOT IN FULL TIME MINISTRY
Will you need lodging?*	YES NO
Name (Wife)
Name (Children) & age
Name (Children ) & age
Name (Children) & age
Name (Children) & age
Additional Comments	web forms software
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