PLEASE FILL OUT THIS FORM COMPLETELY.

Please make checks payable to [If you are mailing.]: Georgia State Council Usher Board Auxiliary.

Church Name *

GSC Council *

• FEBRUARY
• JUNE

Date *

Pastor's Name *

Church Address *

Address Line 1

Address Line 2

City

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Zip Code

Phone *

Local President Name *

Local President Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Local President Phone

Local President Email

Submitted By Who *

Are You Reporting More Than 10 Ushers? *

• Yes
• No

Please Select How Many Ushers Are Reporting *

• 1 - $10.00
• 2 - $20.00
• 3 - $30.00
• 4 - $40.00
• 5 - $50.00
• 6 - $60.00
• 7 - $70.00
• 8 - $80.00
• 9 - $90.00
• 10 - $100.00

Church Report

• Church Report ($25.00)

State President Love Offering

• State President Love Offering ($20.00)

Would You Like To Donate To Ways 'N Means Special International Offering (copy) *

• Yes
• No

Please Enter Your Donation Amount Below:

0.00

TOTAL DUE:

$0.00

Please Select Method of Payment *

• Credit/Debit
• PayPal

Stripe Credit Card *

Card

Name on Card

Website

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