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Requests Submission Form
Instructions:

1. Please provide ALL information requested
2. You may use first name only if desired
3. Phone number Optional
4. No Attachments (will not accept)
5. Do not use All Caps in request field

We do not share any personal information with anyone.

NO SOLICITATIONS PLEASE

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Name:
Company:
Phone:
E-Mail:
City:
State:
Zip Code:
Country:
Please check all that apply to you: I have found Salvation through Jesus Christ. I would like to learn more about Salvation. I read my Bible regularly. I live my life for The Lord About Church I attend Church regularly I am in a "Home Group" I Pray regularly I minister to others I would like to become a Prayer Warrior Yes No
Prayer Request Prayer Updates Personal Prayer Response

DISCLAIMER:
Disabilities Ministries will not be responsible for the contents of the prayer requests, updates and articles sent to Disabilities Ministries and reserve the right to edit, correct or refuse to publish information sent to us.