Request Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=90 BGCOLOR="#006699" TEXT="#080000" background="009bc0d3.jpg"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>Freedom Rains Ministries</B></FONT><B>    </B><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="Freedom Rains Ministries"><U><B>home</B></U></A></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="Freedom Rains Ministries"><U>Freedom Rains Ministries</U></A>   |   <A HREF="id6.htm" TARGET="_top" TITLE="Who we are"><U>Who we are</U></A>   |   <A HREF="id8.htm" TARGET="_top" TITLE="GoodSearch"><U>GoodSearch</U></A>   |   <A HREF="id16.htm" TARGET="_top" TITLE="Statement of Faith"><U>Statement of Faith</U></A>   |   <A HREF="id10.htm" TARGET="_top" TITLE="Let Us Serve You"><U>Let Us Serve You</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="Childrens Programs Director"><U>Children's Programs Director</U></A>   |   <A HREF="id11.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A>   |   <B>Request Form</B>   |   <A HREF="id15.htm" TARGET="_top" TITLE="Christian Counseling"><U>Christian Counseling</U></A>   |   <A HREF="id12.htm" TARGET="_top" TITLE="Messages"><U>Messages</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" height=390 BGCOLOR="#99CCFF" TEXT="#080000"> <bR> <bR> <bR> <div> <B> <FORM METHOD="POST" ACTION="mailto:jthomas@freedomrains.org"><BR> <div align="Justify"> <br><br> <INPUT TYPE="text" NAME="First & Last Name" SIZE="30">First & Last Name<BR> <INPUT TYPE="text" NAME="City, State" Align="Justify" SIZE="30">City, State<BR> <INPUT TYPE="text" NAME="Phone Number" SIZE="30">Phone Number<BR> <INPUT TYPE="text" NAME="E-Mail Address" SIZE="30">E-mail Address<BR> <INPUT TYPE="Checkbox" NAME="Worship" Value="Worship Service">Worship Service<BR> <INPUT TYPE="Checkbox" NAME="Workshop" Value=" Workshop">Workshop<BR> <INPUT TYPE="Checkbox" NAME="Worship" Value="Speaking Engagement">Speaking Engagement<BR> <INPUT TYPE="Checkbox" NAME="Children's Events" Value="Children's Events">Children's Events<BR> <INPUT TYPE="Checkbox" NAME="Other" Value="Other">Other (please specify in Comments Box).<BR> <TextArea Name="Comments" Rows="5" Cols="40"></Textarea> <Button Type="Submit" Value="Submit" Name="Submit">Submit Form</Button<BR> <Button Type="Reset" Value="Reset" Name="Reset">Reset Form</Button </FORM>  </B></div> <bR> </td> </tr></table></body>