Mask Request Form

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Mask Request Form

The Adanich Family has purchased about 200 dental masks (think surgical look) to share with those that need them. At your request, they will put a mask or masks in a baggie and deliver it to your front door.

Ruth Herman and other sewists are also sewing fabric masks for our church family. At your request, a member of our Gopher team will deliver one of these washable masks to your front door.

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* Indicates required question

Name *

Your answer

Phone Number *

Your answer

Delivery Address *

Your answer

What type of mask would you like? *

Dental Mask

Fabric Mask

Required

How many of each would you like?

Your answer

Any special delivery instructions?

Your answer

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This form was created inside of Brecksville United Methodist Church. Report Abuse