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Prayer Requests Submission Form
Please complete this form to contact the church of any prayer concerns you have regarding yourself or others. A copy of the form will be placed in the 24 hour Prayer Room of
Main Street Baptist Church.

My First Name:
My Last Name:
My Phone:
My Email:
Name of Person Being Prayed For:
Your Relationship to the Person:
Prayer Request (brief and concise)

Is this person an MSBC member?
May we send this person a note of encouragement?
Person's address or email