JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Refuah Shlemah - Names Submission
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Submit names for inclusion in the healing prayer for this week (Monday-Sunday)
**Names will be included for all services this week; please do not submit twice in one week**
**To submit a name for inclusion on our list on an ongoing basis so that you do not need to submit it weekly, or to remove a name from that list, please email
support@romemu.org
Your name:
*
Your answer
Name of ONE PERSON to include in our healing prayer (as you would like it to appear):
*
(Please only enter ONE NAME; if you have additional names, please fill out the form once for each person.)
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Romemu.
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report