Join our Birthday List!
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We would like to update our database to include  birth dates.

Please fill out this form so we can update our records and send special birthday greetings your way!
 
We will not share this information.  
Our intention is only to share in the fun of your birthday celebration!

What is your first name? *
What is your last name? *
What is your phone number? *
What is your birthday? *
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