Glad Helpers/International Prayer Request Form

Check the time of day each person is praying with us (select one):

If the person is unable or unwilling to participate, or if he / she is unaware of your request, the name will be placed on our Surround Prayer list.

Person One

First Name

Last Name

This person is deceased

He / She will join you in prayer at this time:

Morning Noon Sunset Evening Surround

Person Two

First Name

Last Name

This person is deceased

He / She will join you in prayer at this time:

Morning Noon Sunset Evening Surround

Person Three

First Name

Last Name

This person is deceased

He / She will join you in prayer at this time:

Morning Noon Sunset Evening Surround

Please add me to the prayer list

Your First Name

Your Last Name

I will join you in prayer at this time:

Morning Noon Sunset Evening Surround

Contact Information

Name^*

E-Mail^*

Confirm E-Mail

Telephone

Address Line 1

Address Line 2

City

State / Province

Zip Code

Please include any Comments or Questions you may have.