Nomination Form I would like to nominate the following person:Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country AgeAge*18 to 30 years old31 to 50 years old51 to 70 years old71+Are they an active church member?*YesNoWhere do they attend church?*They serve as:*MinisterLaypersonRegional Location*NorthwestNortheastWest CentralCentralEast CentralSouthwestSouth CentralSoutheastAssociation*Barry CountyBethelBlack RiverBlue River-Kansas CityCane Creek StoddardCape GirardeauCarroll-SalineCharlestonClay-PlatteConcordCrossroadsDallas CountyDent-PhelpsEleven Point RiverFellowshipFranklin CountyGasconade ValleyGrand CrossingGreene CountyHarmonyHarrisonHeartlandHeritage SouthernHowellJeffersonLacledeLamineLawrenceLighthouseLinn-LivingstonMaconMeramecMid-LakesMid-MissouriMiller CountyMineral AreaMonroeMt Salem-WyacondaMt ZionNew LifeNorth Grand RiverNorth MissouriOsage RiverOzark PrairiePhelps CountyPleasant GrovePulaskiReynolds CountySalt RiverShoal CreekSoutheast MissouriSpring RiverSt FrancoisSt JosephSt Louis MetroTexas CountyThousand HillsTri-CountyTwin RiversWayne CountyWebster CountyWest CentralWright-Douglas-OzarkSpecific reason(s) for nominating this person:*Do you have permission from this person to submit their name?*YesNoChoose the board, agency or commission on which you believe this person could best serve the Lord and Missouri Southern Baptists:*Hannibal-LaGrange UniversityMissouri Baptist UniversitySouthwest Baptist UniversityThe Baptist HomeWindermereMissouri Baptist Children's HomeMissouri Baptist FoundationMBC Christian Life CommissionMBC Historical CommissionMBC Executive BoardInformation for Person Submitting NominationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Church*
