Fri, Nov 21, 2008 
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Healing Request Form
Name * :
Gender * : Female Male
Location (City & State) * :
Age (approximately) :  
Requesting healing for the following condition(s):
· Specify the condition for which you are requesting
· In case of disease, kindly give a brief description about the present stage, signs and symptoms
Do you have a preference? : Distant healing Prayers
Request Sent By      
Please add your E - mail address * :
   

 
 

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