Baby Bottle Sign-Up

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Baby Bottle Sign-Up Form

First Name

Last Name

Email

Church Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How many baby bottles will your church need?

Checkbox

Pick-Up at the Waite Park Clinic (141 Waite Avenue North, Waite Park) 10am - 5pm Monday thru Friday.

Delivery (PRC will deliver them to your church)

Date baby bottles are needed by:

MM

DD

YYYY

Time range for pick up or delivery:

What time will you pick up at the Waite Park Clinic (141 Waite Ave North, Waite Park)? Or what time is your church open for delivery?

If you have any questions, please enter your questions below or contact Beth Bentrud by phone (320) 253-5333 or by email at bethbentrud@preghelp.com.