If
A Special Need Arose
Names of those (including children) who would help if an emergency
or special need arose.
Name:
Telephone:
Address:
Name:
Telephone:
Address:
Name:
Telephone:
Address:
O
References
Please list three (3) members of The Mother Church who are not related
to you, including one (1) advertised Christian Science Practitioner
acquainted with your affairs and to whom reference may be made:
(Please list Practitioners first.)
Practitioners Name:
Address:
Telephone:
How Acquainted:
Practitioners Name:
Address:
Telephone:
How Acquainted:
Practitioners Name:
Address:
Telephone:
How Acquainted:
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