Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

T-Shirt Size *

Limited to available stock.

Small

Medium

Large

X-Large

XX-Large

XXX-Large

T-Shirt Color *

Limited to available stock.

Black

Olive Green

I understand that my selection will be honored if it is available. If it is not available, I will be contacted to select an alternate color or merch item if t-shirts are out of stock. *

I understand

I understand that if I am not located in Yuma County, the item will be shipped to me at no cost. And if I am located in Yuma County, I am to pick my item at Church For The City during office hours. *

I understand

I understand that I am only eligible to receive this free item if I am within the first 30 to submit this form after it is posted during the online service I am attending, and that this will be determined objectively based on date/time this form is submitted. I understand I am not guaranteed to win. *

I understand