Prayers/Intentions

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Name (First and Last) *

Your answer

Email Address (if you do not have one, answer N/A) *

Your answer

Phone number *

Your answer

Best way to reach you: *

Phone

Email

List the names of those you would like us to pray for

Your answer

Any Concerns/Intentions you would like us to pray for?

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Other prayer requests?

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Would you like to be contacted about the above? *

Yes

No

Indifferent

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