[\/vc_column_text][vc_row_inner][vc_column_inner width=”1\/4″][vc_single_image image=”562″ img_size=”full”][\/vc_column_inner][vc_column_inner width=”3\/4″]\n

\n Please use this form to submit your prayer requests. Be assured that any information submitted here is confidential<\/span>\n <\/div>\n

Today's Date*<\/span><\/label>
\n \n Date Format: MM slash DD slash YYYY<\/span>\n <\/div>\n <\/li>
Type of Prayer Request
*<\/span><\/label>
- \n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\tPersonal - General Requests<\/label>\n\t\t\t\t\t\t\t<\/li>
- \n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\tOn Someone's Behalf - General Requests<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li>
- Name*<\/span><\/label>
  \n \n \n \n First<\/label>\n <\/span>\n \n \n \n Last<\/label>\n <\/span>\n \n <\/div><\/li>
- Phone<\/label>
  <\/div><\/li>
- Email<\/label>
  \n \n <\/div><\/li>
- Your Prayer Request*<\/span><\/label>
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