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 Your Email* Enter Email Confirm Email District or Location of Service* Beacon Capital Corridor Fairway Gateway Harbor Heritage Sound Conference Staff Description of Prayer Request - With Conference Affiliation*Please include the who, what, when, where, and why of the situation. If the contact information is to be shared, please include it also. Example: Joe Big & Sue Small (Church Name) got married on January 1, 2017, in Sioux Falls. You may contact Joe and Sue at firstname.lastname@example.org or send cards to 700 Waterfield Ridge Place, Garner, NC 27529.Permission*Do we have permission to send this Conference-wide? Yes No (Only Conference Office) Contact Person & Relationship*Please make sure we have a name and relationship if the request is for a widow, conference staff, or key district person(s). Contact Person's Phone*Please provide a cell (preferred) or home phone number for the clergy this request is referencing? EmailThis field is for validation purposes and should be left unchanged.