*Name:
*Phone:
Email:
*Name of person(s) to pray for:
*Specific prayer request for this person(s):
*Relationship to you:
*Would you like this request published in our Sunday Church Bulletin and Newsletter Yes No
(Please note: by authorizing CUMC to include an individual’s name in our bulletin or newsletter, you are confirming that you have secured the permission of the individual being prayed for to have their name published)
*Would you like this request to be shared with our confidential Prayer Chain?Yes No
*Would you like a follow-up phone call from our Pastoral and Congregational Care staff to confidentially discuss this request? Yes No