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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe 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*
