Form Test

Name

Are you a member or regular attender of Redeemer LSQ?

If yes, when did you start attending LSQ?

Please list approximate month and year.

If no, how did you find us?

(Friend, social media, email forwarding, etc.)

Where are you tuning in from?

List your city, state and/or country.

Are you currently in need of help? If so, please check all that apply:

Hold down the Shift button when choosing more than one option.

Would you like to receive more information on any of the following? Check all that apply:

Hold down the Shift button when choosing more than one option.

Prayer Request

These requests will be shared with the LSQ Staff and the LSQ Prayer team.

Would you like to pray over the phone with an LSQ staff member or officer? (If yes, please include your phone number.)

Cell Phone