Community Baptist Church of Greater Milwaukee

CBC Van Transportation Request Form (rev.10.1016)

Please fill out and submit by 4:00 p.m Friday mornings

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Please fill out all areas of this form to sign up for our van service. You can also call the church office, 414-445-1610, to sign up or if you are in need of more information. If you have more than 5 individuals needing this service, please call the church office for more information.

Name *


First Name	Last Name

Address *


Address

Address Line 2

City	State	Zip Code

Phone *

Phone Number

Choose the service you will need transportation to and from *

Select from list

How many individuals will need the service? *

Select from list

* required