Baby Bottle Campaign Order Form

Please fill out the boxes below to provide us with information to prepare your baby bottle campaign boxes. If you have any questions, please call 703-780-4700. Thank you once again for your assistance in raising funds to help us assist many women and families!

Your Name / Baby Bottle Campaign Liaison:

Best Phone to Reach You:

Your Email Address:

Church Name:

Church Address:

Church Phone:

Number of Boxes of Bottles Requested: (40 bottles/box)

1st choice for Campaign Dates: (such as May 10 - June 9)

2nd choice for Campaign Dates:

(Campaigns usually last 4 weeks. More information will be provided once you sign up.)

I will pick up the baby bottles at NOVA Pregnancy Center's