Your Contact Info:

Your name:

Daytime phone number:

Email address:

The Birthday Person:

Name and city of residence:

Which birthday:

Birth date:

Birth place:

Family of birthday person:
Spouse's name and hometown; children's names, their spouses and hometowns; number of grandchildren and number of great-grandchildren.

Are you planning a celebration:
Yes
No

Celebration address (if applicable):

Cards of congratulations should be mailed to:

The Photo:

How do you plan to submit the birthday photo:
Electronically (use the tool below to upload the photo directly from your computer)
By e-mail (Please send your photo as an e-mail attachment to reporter@mccookgazette.com after submitting this form.)
By dropping it off in person
By sending it via postal mail (Address it to: McCook Gazette, P.O. Box 1268, McCook, NE, 69001)
I don't plan on submitting a photo

Note: If mailing or dropping off a hard copy photo, please include a self-addressed, stamped envelope to receive the photo back. You can also pick up the photo later at our office.:

Upload photo:
Use the button to select the image from your computer, JPEG format preferred, if available.

Additional Information:

Comments:
In this space please indicate the birthday person's local connection to Southwest Nebraska / Northwest Kansas, if not indicated anywhere else, as well as any further requests you might have.