Request-a-Prayer Registration

Request-a-Prayer Service

Tell us about the friend or relative that needs our prayers:

Person's First Name:
Person's Sex:
His/Her Mother's First Name:
	Leave the mother's name blank if you don't know it

Now, tell us a little about yourself:

Your First Name:
Your E-mail Address:
	An automated e-mail will be sent to this address. Follow the instructions in that email to confirm your request.

	I would like to make a tax-deductible donation to support this service I would like information about becoming a member of Congregation Shaarey Zedek

We need to make sure there is a real person filling out this form, and not just a robot. So to prove you're a real person, just type the word you see in the picture below. If you can't read the word, click the link below the picture to see a different picture.

The word in the picture is:

If you can't read the word, click here for a different picture.

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