We believe in the power of prayer! As we begin 2008, we are compiling an updated list of persons who are in need of prayer. We commonly refer to this as a “Sick List” or “Prayer Request List”. Please complete the form below and hit submit. The names submitted will continue on the list for approximately one month. If you wish to extend that period, please Email us at mail@loacc.org.

Name of Sick person:

Hospital/Nursing Home/House:

Address:

City:

State:

Zip Code:

Phone Number:

Contact Person:

Relationship:

Phone Number: