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GA Traveling Chalice Request

First Name(*)
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Last Name(*)
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E-mail(*)
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Shipping address(*)
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City(*)
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State (choose one)
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Zipcode(*)
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Daytime phone(*)
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Evening phone
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Congregation(*)
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Would you be willing to transport to nearby congregations?
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Nearby Congregation 1
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Nearby Congregation 2
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Nearby Congregation 3
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Nearby Congregation 4
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Comments
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