Food Box Nomination

Poland Church would like to bless those in our community and the greater Mohawk Valley who are in need with a gift of food. If you know someone who would benefit from this donation, please nominate them using the form below. Before we can place our order for the food boxes, we must confirm with the nominee their acceptance of the love offering and set up delivery.

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Your Name:

Do you wish to remain anonymous?

Nominee Name:

Nominee Phone:

Accepts Texts?

Nominee Address:

Nominee City:

Nominee Zip:

Nominee Email:

Number of Adults:

Number of Children:

Submit