Initiative Helping People Help People
Thank you for helping us help others. Use this form to submit the name of the person you would like to receive a James 1:27 Encouragement kit. With your first request we will also send you a "sample" so that you will know what they are receiving.
Were You referred by someone?
Yes
No
Person's Name that referred you
*
Is this your first request?
*
Yes
No
I want to deliver Kit myself.
*
Yes
No
Your Name
*
First Name
Last Name
Your E-mail
*
example@example.com
Your Contact Number
*
Format: (000) 000-0000.
Your Street
*
Your City
*
Your State
*
Your Zip Code
*
Full Name of Recipient : (Person Receiving The Encouragement Kit)
*
First Name
Last Name
Recipient's Street
*
Recipient's City
*
Recipient's State
*
Recipient's Zip Code
*
Number of Other People In Home
*
Known Food Allergies?
*
Yes
No
Because of Food Allergies, scones will not be included in Kit
Special Instructions
Submit
Should be Empty: