Prayer, Praise  & Visitation Requests
Please feel free to fill in any or all information - if this form does not work please call (863)-665-1344 or  e-mail us at clumch@netzero.net
What is the nature of your or the person's need.
Physical Need Spiritual Need Finances Loss of a loved one Praise Report More infomation about church
Is prayer or contact requested.
		Prayer	Contact	Both
If contact is requested would you like us to visit, call or Email.
	Phone contact		Visit		E-mail
Personal Information
First Name
Last Name
Home address, Name of Hospital or Nursing Home
City
State
Zip/Postal Code
Country
Phone( include Area Code)
E-mail
AFTER RECEIVING YOUR REQUEST OUR PRAYER CHAIN OF DEVOTED MEMBERS OF THE CHURCH WILL BE NOTIFIED AND WILL PRAY FOR YOUR NEEDS.
IF CONTACT IS REQUESTED, OUR PASTOR OR A MEMBER OF THE CHURCH WILL VISIT OR CALL.
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