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Prayer Recipient Sign-Up Form

We would love to pray with you! The Prayer Team is available each Monday evening from 6pm-8pm for prayer. Please take a moment to answer some questions so that we are better equipped to support you.

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
*Preferred Contact Method:
*Please provide a brief description of your prayer needs:
*Which time slot works best for you?:
*Have you accepted Jesus Christ as your personal savior?:
*Emergency Contact Name:
*Emergency Contact Phone Number:
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