APPLICATION TO PARTICIPATE IN FLOSSMOOR 40 DAYS FOR LIFE

All groups must read and agree to the Code of Conduct first before applying.

Church/Organization/Individual Coordinator:

Address:

City:

State:

Zip Code:

Second Phone:

Adopt A Day First Choice:

Adopt A Day Second Choice:

Adopt A Day Third Choice:

Number of Days Requested:

Comments:

Read the code of conduct:

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CHANGE A LIFE TODAY

Abortion is the leading cause of death in the United States with an approximate 1.2 million children losing their lives every year. The problem is sometime overwhelming and incomprehensible, but we know that “With God all things are possible.”