:: FUMCB :: Need Prayer?
None of the fields below are mandatory except in the case where you wish to be contacted by a member of the church. You may fill-in all of the fields to request information or submit an anonymous prayer request.
FIRST NAME:
LAST NAME:
ADDRESS:
CITY:
STATE:
ZIP:
EMAIL:
PHONE:
I AM A:
select...
Member
Visitor
I WISH TO HAVE INFORMATION ABOUT FUMCB SENT TO ME.
select...
Yes
No
I WISH TO HAVE SOMEONE FROM THE CHURCH TO CONTACT ME.
select...
Yes
No
PRAYER REQUEST:
Prayer IS FOR:
select...
Myself
Family Member
Other... please specify >
Name of HOSPITAL OR FACILITY:
(IF APPLICABLE)
DATE OF PROCEDURE OR NATURE OF ILLNESS:
(IF APPLICABLE)
QUESTION/COMMENT:
