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Fresh Change Bag Registration
By filling out this form, you commit to filling the number of bags you register appropriately and sending them to the address provided by Global Refuge. Please budget for shipping costs when selecting your bag quantity.
Which location are you registering to send your bags to?
Account Name
Contact Information
First Name
Last Name
Email
Street Address
City
State
Zip Code
Number of bags being sent
Men's Small
Men's Medium
Women's Small
Women's Medium
Personal Care Kit
Diapers and Baby Wipes
Metro Cards
Expected shipping date
Are you a member of an Organization or Faith Community?
Please select...
Yes
No
Organization Information
Organization Name
Street Address
City
State
Zip code
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LIRS Advocacy
