Journey Center Prayer Request Form

Thank you for taking a few minutes to fill out our Prayer Request Form. Please call the Journey Center at 707/578-2121 to let us know about your prayer request if this form does not work for you. Someone from the Journey Center will contact you, if requested.

Please use the box below to type in your prayer needs.

(Your prayer needs will be forwarded to the Journey Center prayer team. If you desire to keep your identity confidential, check the box below. Please note, this form will not give us personal information about yourself unless you type it in.)

Please keep my identity confidential. (Only the person processing this form and the person contacting you (if requested) will see your contact information.)

Please tell us a little more about yourself.

Have you attended Journey Center events before? Yes No

How did you learn about Journey Center? (Check all that apply.)

Friends Newspaper/Magazine Website Newsletter Harmony Festival

Other (Please indicate.)

Please use the following space to write any additional comments.

Contact Information (If you desire someone to contact you regarding your prayer request)

Please contact me regarding my prayer request? Yes No

Name

Phone Number

Email

Address

City

State

Zip

Preferred method of contact: Phone Email Writing

Thank you for taking the time to fill out the prayer request form. Click on the submit button to send us the information. You will be directed to a confirmation page to assure you that this form has been sent. Please contact the Journey Center at (707) 578-2121 if you have any trouble using this form.