Hendricks County Flyer, Avon, IN

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June 11, 2009

Birth Announcement Form

CNHI

AVON —



Order Fulfillment

 

HENDRICKS COUNTY FLYER TEXTsm.gif (5638 bytes)

Attn: Celebrations writer

8109 Kingston Street, Suite 500

Avon, IN 46123





 

Baby's Name: *required field 

 		 Male or Female? * required field 

 
Birth Date: * required field Time of Birth: * required field

  
Weight:* required field

 		 Height: * required field

  
Hospital:

 		 Siblings (ages and names):
Parents: (names and city of residence):* required field

 		 Grandparents: (names and city of residence)

Photo emailed: Yes   No

To submit photos, send email to: Courtney Essett or for questions phone (317) 272-5800 ext. 173
 
PAYMENT INFORMATION:
Name as it appears on Credit Card:  
Cardholder's Address:  
Cardholder's City:  
Cardholder's State  
Cardholder's Zip:  
Phone # of Cardholder:  
Card Type:  
Card Number:  
Expiration Date:  


3-Digit Security Code:

 

Please enter the 3-digit security code found on the back of your credit card within the signature field.
Total Amount: $
I have read the above and understand this announcement will be edited to the Flyer's style. I also understand the Flyer is not responsible for lost or damaged photos.



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