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Name
First Name
*
Last Name
*
Phone
Email
*
Care Need
Prayer
Speak with a pastor about a mental health concern
Death in the family
Grief Support
Meals
Encouragement
Ride to church
Nursing home / hospice visit
Physical home need (repairs)
Visitation (home or hospital)
Memorial service (pastor and/or venue request)
Wedding (pastor and/or venue request)
Other (please explain below)
Bride's name
Detail of other request
Name of deceased
Groom's name
Does bride attend the church?
Yes
No
Does groom attend the church?
Yes
No
Requested date
Alternate date
Type of request
Would like to have a pastor from this campus marry us
Would like to request both a pastor and venue
Type of request
Would like to request a venue for the service
Would like to have a pastor from this campus officiate the service at another venue
Would like to request both a pastor and venue
Would you like to request a particular pastor?
Approximate number of people you expect to attend
Leave this field blank
Submit