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									                                         Fruit Cove Baptist Church
                                                    Missions House
Request for consideration of mission's house use                                        Date:
Organization:                                           Contact Information (how do we reach you):




Name:

                 (first)                                (middle)                                   (last)
Spouse's Name:

                 (first)                                (middle)                                   (last)
Children's Names:                                                               Age:

                 (first)                                (middle)


                 (first)                                (middle)


                 (first)                                (middle)


                 (first)                                (middle)


                                                                                    Special Needs:
First choice of dates:
                            to
       (yyyy/mm/dd)                      (yyyy/mm/dd)
Second choice of dates:
                            to
       (yyyy/mm/dd)                      (yyyy/mm/dd)


                                                        Comments




Instructions:
1)   Please complete all sections of the form.
2)   When complete fax (904-287-1579) or email to Fruit Cove Baptist Church (address below).
3)   You will be contacted by a representative of the church to acknowledge receipt and to discuss your request.
4)   If you have any questions, please contact the church.




     www.fruitcove.com                             Fruit Cove Baptist Church
     info@fruitcove.com                               501 State Road 13
                                                   Fruit Cove, Florida 32259
                                                         (904) 287-0996

								
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