Prayer Request

Please complete with as much information as possible. Fields with an asterisk (*) are required.

Person to Pray For

First Name:

Last Name:

City:

State:

ZIP Code:

Phone Number:

E-mail Address:

* Prayer Request (max. 750 characters):

* Is this prayer request confidential?

Yes No

Person Making Request

Name:

Phone:

E-mail Address:

Are you a member of CUMC?

Yes No