Morale, Welfare, and Relief

Morale, Welfare, and Relief

REQUEST FORM

DATE:___________________________________ 
CHURCH NAME & ADDRESS_________________________________________

_____________________________________________________
PHONE_______________ EMAIL_______________________
LMSG CHURCH LIAISON: ______________________________________
IS THIS A ROUTINE OR EMERGENCY REQUEST?

ROUTINE:______________ _______________________________

EMERGENCY EVENT:___________________________________________________

_________________________________________________________________
NAME OF PERSON OR PERSONS INVOLVED:_____________________

WHAT IS THE REQUEST FROM LMSG: ___________________________

HOW WILL THIS REQUEST OVERCOME THE EVENT? _____________

DESIRED OR REQUIRED AMOUNT $___________

REQUEST SUBMITTED BY: (or designee with contact information) (at least 2 of 3 signatures)
CHURCH PASTOR SIGNATURE: _____________________PHONE____________

CHURCH PRESIDENT SIGNATURE __________________PHONE____________

CHURCH LIAISON SIGNATURE: ____________________PHONE_____________

**(Please print request form, sign and mail to: LMSG C/O Dwight Johnson, 6640 Northwind Dr. Colorado Springs, CO 80918 OR scan and email to Dwight Johnson)