birth

Document Sample
birth Powered By Docstoc
					                   PLEASE PRINT:
                   Mother’s name:
                   Mother’s maiden name:
                   Father’s name:
                   Parent’s address: (city and state only)
                   Phone:
                   Baby’s full name and sex:

Date of birth:
Time of birth:
Weight and length:
Place of birth:
List complete names, sex and ages of siblings*:


Grandparents*:




Great-grandparents*:




*PLEASE USE BACK OR ATTACH A SHEET IF
MORE ROOM IS NEEDED.


      Job#
ADDITIONAL INFORMATION




    New Arrival                    Engagement                               Wedding               Anniversary

     Basic          $30       No photo - up to 150 words
     Standard       $40       1 photo - up to 150 words
     Deluxe         $50       1 photo - up to 350 words
     Deluxe II      $50       2 photos - up to 150 words
                              Payment required with submission of form
 Name:

 Address:

 City:                                             State:                             Zip Code:

 Phone:

 Email Address:

 Cash/Check:

 Credit Card #:                                                                          Exp. Date:
                          (Please circle type of card)

 Signature:

               Commercial-News • 17 W. North St. • Danville, IL 61832
                 DEADLINE FOR SUBMISSIONS: 8 days prior to run date, by noon on Friday.
       YOU WILL RECEIVE 5 BONUS COPIES of the Commercial-News day of the announcement.
                 Copies must be picked up from our office within one week of publication date.
  Jpg digital attachments can be sent to keepsakes@dancomnews.com. Color or black and white pictures
  should be sharp and clear but may be any size. You may pick the picture up after the run date or leave a
        self-addressed stamped envelope for return of picture. Any questions call (217) 446-1000.


                                                  www.commercial-news.com

                                       Your News. Your Paper. Every Day.

				
DOCUMENT INFO
Categories:
Tags:
Stats:
views:3
posted:7/30/2012
language:Unknown
pages:2