Buffalo Reflex

Birthday Announcement:

Please enter your birthday announcement below:

* Required Fields

First name of honoree: *

Last name of honoree: *

Date of Birth: *

Age on Birthday: *

Parents:

Married:

Is spouse living?: Yes No

Children (and spouses):

Job, church and club affiliations:

Any additional interests:

Type of celebration planned:

Date of Celebration:

Time of Celebration:

Place of Celebration:

Date to run the birthday announcement: *

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.) *