The Valley Breeze Birthday Club
For print editions only. Submissions must be received by the last Friday of the month prior to the birthday.
Birthday Wish Recipient
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
From
*
Optional Birthday Greeting (10 words Maximum)
0/10
Edition(s)
*
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( X )
Cumberland/Lincoln Edition
$2.00
$
2.00
North Smithfield/Blackstone/Woonsocket Edition
$2.00
$
2.00
Observer Edition
$2.00
$
2.00
North Providence Edition
$2.00
$
2.00
Pawtucket/Central Falls Edition
$2.00
$
2.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Contact Name
*
First Name
Last Name
Contact Email (for questions, not publication)
*
example@example.com
Contact Phone Number (for questions, not publication)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: