Anniversary Receptions

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:
West Plains Daily Quill
205 Washington Ave., P.O. Box 110
West Plains, MO 65775