Grocery GiveAway
Contact Information
First Name
*
Last Name
*
An email address or phone number is required.
Mobile Number
Email Address
Mailing Address
Mailing Address Line 2
Mailing City
Mailing Zip Code
Mailing State
I am:
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New to CROSSROADS
Visited CROSSROADS more than once
Member
Household Information
Number of People in Household
*
Number of Children (0-17)
*
Number of People Under 22
*
Number of Disabled Seniors (60+)
*
Yearly Income
Less than 20,000
20,000 - 30,000
30,000 - 40,000
40,000 - 50,000
How can we help you?
Would you like to receive our weekly e-devotional letter?
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Yes
No
Would you like to be contacted by a staff member? If so, please tell us why so we cant connect you with the right person.
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How did you hear about CROSSRAODS Grocery GiveAway?
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