Christian Life Center - Media Order Form

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Name *
Address *
City *
State *
Zip Code *
Phone Number *
E-mail Address: *
Date of Worship Service *
Time of Worship Service *
Media Type *
Quantity *
How will you recieve your order? *	I will pick-up and pay at the CLC Media Resource Center. I am sending a check and am including an additional $2 for shipping. (Mail orders will not be processed until payment is received.)
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