Anniversary Announcement

First and Last Names of Couple: *

Wife's maiden name: *

Address of Couple: *

P.O. Box/Apt #

City *

State *

Zip Code *

Number of Years Married: *

Wife's Occupation:

Is she retired?

Yes

Husband's Occupation:

Is he retired?

Yes

Names of children, including cities of residence:

Number of grandchildren:

Number of great-grandchildren:

Please choose a method to submit your photo:

Mailing photo

Attaching photo via this form

Not sending photo

Attach photograph in JPEG/JPG format: (File size limit is 5MB) Choose a file

Mail photo to:
Buffalo Reflex
114 E. Lincoln Street P.O. Box 770
Buffalo, MO 65622

First Name: *

Last Name: *

Phone: *

E-mail: (A valid e-mail is required.) *

Cancer strikes — twice!