Cancer Ministry Prayer Request

Cancer Ministry Prayer Request

All information is kept confidential
YesNo
Please read:

In order to register your loved one for this ministry, permission must be given by the person facing the cancer.
Who are we praying for?*

First NameLast Name
YesNoThis is for myself.
For mailing purposes, please enter "in care of" first and last name:
Type of cancer*
Please feature your/their name (ex. Jane D.) in the Shrine's prayer brochurePlease enter your/their name into the Perpetual Book of PrayerPlease send a prayer packetPlease send a prayer shawl or prayer lap blanket
Please mail out Prayer Cards (over a 28-day period)Please register you/them into the Online Prayer Companion (an email address is required)
Email address for the Person we are Praying for to be registered for an Online Prayer Companion:
Email of the person we are praying for
The Person we will be praying forThe caregiver's email address
Prayer shawlPrayer lap blanket
Address*

Street Address

Unit or Apartment Number

CityState / Province

Postal / Zip CodeCountry
Please tell us something about you/them. Describe current treatment*
If this prayer request is not for you, please fill out the below information
Your name

First NameLast Name
Your phone number
Format: (000) 000-0000.
Your email
example@example.com
Your relationship to the one who you are requesting prayer for
Should be Empty:

Please read: