NAME: (You must enter your name.)
  

ANONYMOUS: (Select YES if you don't want your name to show up on prayer list.  Your information will only be sent to the church.)

          YES:           NO:

REQUEST: (OPTIONAL)
  

PHONE NUMBER: (OPTIONAL)
  

E-MAIL ADDRESS: (OPTIONAL)
  

WOULD YOU LIKE TO BE CONTACTED BY OUR CHURCH FOR SPIRITUAL GUIDANCE?

          YES:            NO: