Change For Life Request Form

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CAMPAIGN REQUEST FORM

How to participate, 5 easy steps!

Review the options and tips below, choose the time of year you want to launch your campaign, and complete the form below.
Options Health will contact you to confirm your order and set up a date to pick up your prepared bottles and table signage.
Options Health will prepare your bottles with inserts that include your collection date.
Plan ahead to have a table set up for both your distribution date and your collection date.
At the end of your campaign, contact Options Health to coordinate the drop off of your filled and unused bottles.

When choosing a date for your campaign, consider these options & helpful tips!

Winter Campaign to coincide with Sanctity of Human Life Sunday
Spring Campaign to run from Mother's Day to Father's Day
Holiday Campaign to run from Thanksgiving to Christmas
All campaigns will run for a minimum of 4 weeks and maximum of 6 weeks
Make sure you have permission to set up a table for your bottle distribution and collection dates.
You will want to promote the baby bottle campaign in advance of the bottle distribution and collection dates. Options Health will provide you with a short promo video as well as a slide deck for the distribution and collection dates!

Bottle Distribution Date*

Number of Bottles Needed*

First Name*

Last Name*

Phone*

Email Address*

Please select your church

If you selected "other church" or are a different organization type, please list your church or organization name below

By checking this box, I am requesting this campaign as an authority of my church/organization or with the expressed permission from my church/organization.*

SUBMIT REQUEST

Org Address Line 1, Org City, Org State Org Zip • Org Phone • Org Email

How to participate, 5 easy steps!

When choosing a date for your campaign, consider these options & helpful tips!

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