"My Very Own Name" Book Order Form:


Child's First Name:
Child's Middle Name: *     (optional)
Child's Last Name
Gender:
Child's Birthday:    
Dedication:
Sender
(i.e. Mom and Dad):

Year book will be given:
Residence   I DO Reside in Illinois
  I DO NOT Reside in Illinois

*Middle Name:
We are happy to include the child's middle name in the book, as an option shown above. $4.95 extra fee applies. Please note that the combination of the child's first and middle names cannot exceed 15 characters. This is due to the format of the book.

Please double check the child's name and birthday. The book will be printed with the information exactly as you have specified. Thank you!

  



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