2024 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 2024 Baby Bottle Campaign and/or Sanctity of Human Life Sunday.
Your Name
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First Name
Last Name
Name of Church
Email
*
Phone Number
*
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Sanctity of Human Life
In this section, please let us know your plans for Sanctity of Human Life Sunday which will be recognized on January 21, 2024. We are encouraging churches and organizations that are participating to launch their Baby Bottle Campaign on Sanctity of Life Sunday.
Does your church or group plan to commemorate Sanctity of Human Life Sunday?
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Yes
Not at this time
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Materials Request
Please indicate which materials you would like to receive:
I would like to receive baby bottles
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Yes
No
Please indicate the number of baby bottles you will need (comes in crates of 30). If you don't know the number, we will send what your church/organization received last year.
I would like to receive Baby Bottle Campaign bulletin inserts
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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
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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)
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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?
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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
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We will pick up these materials from Valley Women's Clinic in Blacksburg.
We will pick up the materials from Valley Women's Clinic in Radford.
We will pick up the materials from Valley Women's Clinic in Wytheville.
Please contact me to arrange a delivery of these materials to me or the church.
Date Planned for Material Pick Up
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Month
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Day
Year
Let us know what day you would like to pick up your materials. (Reminder: we offer hours in the Radford clinic on Mondays, Tuesdays and Thursdays so pick up dates for Radford must be Monday/Tuesdays/Thursday.)
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.
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