Birth Announcement Form

June 11, 2009 10:27 am

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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: Charlee Beasor 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.