First Mediaworks

April 23, 2014 - 6:46am
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Prayer Request/Praise Report Form If you have a prayer request or praise report, please supply us with the information below so that we may be able to pray with you and rejoice with you. You may rest assured that the information will be held in the highest confidence.
* = required field
* Your Name:
* Address:
* City:
* State: * Zip:
* Your E-Mail Address:
Home Phone:
Your Church:
Are you a Christian? Yes No
I am making this request for:
Myself Someone else
If someone else, please enter person's name or relationship:
Please submit your request or praise report below:
May we post this request on our Web Site so that others may pray for you as well? NOTE: We will use only your first name and city.
Yes No
May we publish this request in our Pastor's Letter, which goes to many churches in the area?
Yes No
Would you like someone from The Upper Room to contact you?
Yes No
How did you hear about The Upper Room?
Web Site
KAJN Radio
FamilyVisionTV
At My Church
A friend
Other:


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