MBPC/NBPC MEMBERSHIP APPLICATION

MBPC/NBPC BLACK PRESBYTERIAN CAUCUS APPLICATION FOR MEMBERSHIP 2026

“The Black Family, Congregations and Community in the Presbyterian Church(U.S.A.): Navigating Identity, Equity and Economics —The Year of Virtual Connections”
Today's Date

MonthDayYear
Date
Choose one option for your MEMBERSHIP selection:
Membership / Dues Total
Institutional Mission Partner(IMP)

Other
Enter Amount Below From The Schedule Above
Preferred Title (Please check Appropriate Box(es):
Generation
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Church
Presbytery
Region
Chapter
For Students/Active Military:
Name of College/University/Seminary/ Station:
Major/Concentration
Payment

Methods of Payment: Check, MO or Cash App - Make Checks / MOs payable to the Michigan Black Presbyterian Caucus
Final Total Due
Check #:
Cash App $MBPC482 or Scan the QR Code.

Be sure to type MBPC Membership Payment in the For section.
PLEASE SUBMIT YOUR PAYMENT AFTER COMPLETING THIS APPLICATION
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MBPC/NBPC BLACK PRESBYTERIAN CAUCUS APPLICATION FOR MEMBERSHIP 2026