Concern / Celebration Contact and Description Form Please complete as much information as possible for those who will be following up with the family. Name*Who is completing this form? First Last District*BeaconCapitalCorridorFairwayGatewayHarborHeritageSoundName of who is this prayer request referencing?*Need the person who is connected to the NCCUMC. First Last Phone*Please provide a cell (preferred) or home phone number for the person/family this request is referencing? Conference Affiliation*How is this person affiliated with the Conference? Examples: Pastor of ABC church or UMW Chair of ABC church.Permission*Do we have the permission from the individual or a family member to post this request?YesNoContact Person*Please enter a spouse name, next of kin or another contact for this request. First Last Relationship*What's the relationship of the contact person to the individual/family in the request?Contact Phone*Please provide a phone number for the Contact Person.Description of Prayer Request*Please include the who, what, when, where, and why of the situation. Example: Joe Big & Sue Small got married on January 1, 2017, in Sioux Falls. Joe is with ABC church in XYZ district.EmailThis field is for validation purposes and should be left unchanged.