Serve Brownsville
Serve Brownsville
July 31 - August 3, 2025
Primera Iglesia Bautista Mexicana
3049 Lima St, Brownsville, TX 78521
This application is now closed.
For any questions or concerns, please contact
Teri Ussery
.
Event ID
Please confirm that you are covered by medical/accident insurance?
Yes
No
Unfortunately, you are not able to proceed with the remainder of the application.
Medical insurance is required to participate.
Please contact 214.828.5150 with any questions.
Hidden: Capacity
Max
Count
Remaining
Today
Applicant Information
First Name
Last Name
Mailing Address
City
State
Zip Code
Email
Phone
Gender
Male
Female
Date of Birth
T-shirt Size
Small
Medium
Large
X-Large
2X-Large
3X-Large
Languages spoken (check all that apply)
English
Spanish
Church Information
First, search for the city where your church is located. Next, search for your church name. If you can't find your church in the list, select "My church is not listed." below.
Church city
Church name
Pastor's name
My church is not listed.
Enter church name
Enter church city
Pastor's name
City ID
Church ID
Emergency Contact Information
First Name
Last Name
Relationship
Phone Number
Primary
Secondary
Payment
Payment Type
Credit Card (3% processing fee applies)
eCheck
Registration Summary
Subtotal
$
Total Amount No CC Fee
$
Credit Card Fees*
$
3% added for credit card processing
x
Total
$
Credit Card Information
Name on Credit Card
Credit Card Number
Expiration Month
Expiration Year
Security Code
3-digit security code usually found on the back of your card. American Express cards have a 4-digit code located on the front.
x
eCheck Information
Bank Name
Name of Account Holder
Bank Routing Number
Bank Account Number
Account Type
Checking
Savings
Business Checking
Billing Information
First Name
Last Name
Email
Street Address
City
State
Please select...
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
Zip Code
Authorize.Net Hidden
Authnet_Hidden_Fields
