First Name:

Last Name:

E-mail address:

Phone:

Address 1:

Address 2:

City:

State:

Zipcode:

I am interested in volunteering in the following way(s):

Sidewalk CounselorPrayer SupporterOffice HelpEvents (rallies, vigils)40 Days for LifeOther

I am interested in volunteering in:

Twin Cities Metro Area (MN)Central FloridaDuluth

Church I Attend:

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