2026 Baby Bottle Campaign/Sanctity of Human Life Request Form
This form is for churches and organizations located in the New River Valley of Virginia that are participating in the 2026 Baby Bottle Campaign and/or Sanctity of Human Life Sunday.
Your Name
*
First Name
Last Name
Name of Church
Email
*
Phone Number
*
Format: (000) 000-0000.
Back
Next
Sanctity of Human Life
In this section, please let us know your plans for Sanctity of Human Life (SOHL) Sunday which will be recognized on January 18, 2026. We are encouraging churches and organizations that are participating to launch their Baby Bottle Campaign on SOHL Sunday.
Does your church or group plan to commemorate Sanctity of Human Life Sunday?
*
Yes
Not at this time
Back
Next
Materials Request
Please indicate which materials you would like to receive:
I would like to receive baby bottles (Please note that it is not necessary to count baby donations collected by your church)
*
Yes
No
Please indicate the total number of baby bottles you will need (Note: Bottles come in crates of 30). If you don't know the number, we will send what your church/organization received last year.
1 crate (30 bottles)
2 crates (60 bottles)
3 crates (90 bottles)
4 crates (120 bottles)
Please send me the same number of bottles we received last year
Other
I would like to receive Baby Bottle Campaign bulletin inserts
Yes
No
Please indicate the number of Baby Bottle bulletin inserts you will need.
I would like to receive Sanctity of Human Life (SOHL) Campaign bulletin inserts
*
Yes
No
Please indicate the number of SOHL bulletin inserts you will need.
I would like to receive Digital Resources. (Slides for SOHL & Baby Bottle Campaign, PRC video - they will be emailed to the email address you provided)
*
Yes
No
Is your church or group interested in a speaker from the PRC sharing about our ministry on the day you are kicking off the Baby Bottle Campaign/commemorating Sanctity of Human Life?
*
Yes
No
Details for speaker from PRC (Date/Time requested, contact person, etc):
Pick Up/Delivery Information
Please let us know how you plan to receive the materials you are requesting.
Pick Up/Delivery Method
*
We will pick up materials from Valley Women's Clinic in Blacksburg. (Blacksburg administrative office hours: Monday-Friday 9-5)
We will pick up materials from Valley Women's Clinic in Radford. (Radford office hours: Monday & Wednesday 9-5)
We will pick up materials from Valley Women's Clinic in Wytheville. Wytheville office hours: Monday-Wednesday 9-5)
Please contact me to arrange a delivery of these materials to me or the church.
Date Planned for Material Pick Up
-
Month
-
Day
Year
Let us know what day you would like to pick up your materials. (Reminder: Radford pickups only available on Mondays and Wednesdays, Wytheville pickups only available on Mondays, Tuesdays, and Wednesdays)
Questions/Comments/Other information:
If you know what time of day you plan to pick up materials or if someone other than yourself will be picking up materials, please indicate that here.
Submit
Should be Empty: