<p>Your Name (optional)<br />
    [text your-name] </p>

<p>Your Email (required)<br />
    [email* your-email] </p>

<p>Subject (required)<br />
    [text* your-subject] </p>

<p>My Prayer Request (required)<br />
    [textarea* your-message] </p>


<p>[radio radio-944 default:1 "This message is very confidential and may be given only to Pastor Richard J. Brown or the prayer team leader."]<br />
[radio radio-944 "This message is confidential and may be shared only with the Pastors and the prayer team."]
</p>

<p>[submit "Send"]</p>