Package Delivery Form - RI | EmpowermentandDemocr

Name of Faith Institution or Organization - REQUIRED

Address - REQUIRED

County

Pastor's First Name

Pastor's Last Name - REQUIRED

Contact for Drop Off - TYPE IN ANYTHING IF YOU DON'T KNOW YET SUCH AS "NA" OR "LATER"

Drop Off Contact Last Name - TYPE IN ANYTHING IF YOU DON'T KNOW YET SUCH AS "NA" OR "LATER"

Contact's Email (Optional) Please Include If They Use One Frequently

Drop Off Contact Phone -TYPE IN ANYTHING IF YOU DON'T KNOW YET SUCH AS "NA" OR "LATER"

Drop Off Address - TYPE IN ANYTHING IF YOU DON'T KNOW YET SUCH AS "NA" OR "LATER"

EMPOWERMENT AND DEMOCRACY PROJECT (B-PEP)