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Your Name:
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Your Email:
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Your Phone:
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Name of person needing prayer:
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Details and Comments about Request:
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If the person is in a hospital, please choose:
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Hospital Room Number (if known):
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Location of person other than list above?
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Please check the boxes below that applies to your request:
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Yes, I have permission for you to add this request to Hagood's Website and Prayer list
No, Do not add this to the website but simply have the church staff pray
Please have the pastor call me at earliest convenience
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If a call is requested please give us your contact number:
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