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Sponsor or Host a Clinic
If you are interested in becoming a Host Church, please complete the following form and we will contact you to schedule a meeting.
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* Indicates required question
Name of Church
*
Your answer
Denomination
*
Your answer
Address of Church (including ZIP Code)
*
Your answer
Senior Pastor
*
Your answer
Your Title
*
Your answer
Your Role/Responsibility
*
Your answer
Primary Contact
*
Your answer
Contact's Phone Number
*
Your answer
Size of congregation
*
(we need this for clinic planning purposes only)
Your answer
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