Anniversary Submitter (Tulsa's Christian Music Station is 100.9 KXOJ)

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Name:
Email:
Company:
Street:
City:
State/Province:
Zip/Postal Code:
Phone Number:
Comments:

1. Please furnish the first and last names of the couple celebrating:
2. Please supply the date of the Anniversary
3. How many years have you been married?
4. If you would like your names read on an alternate date, please let us know when:

Thanks for entering- and Happy Anniversary!