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ONLY $15 PER BOX

SAMPLE AD
Please fill out the short questionaire below to submit your information to our ad development team.   You may choose to purcahse more than one box per senior or for multiple seniors.   If you choose to purchase multiple boxes
for multiple seniors, please indicate which senior each piece of
information pertains to.  

EACH BOX IS 5 INCHES BY 5 INCHES FOR ONLY $15

PLEASE NOTE! ALL FIELDS ARE REQUIRED TO BE ABLE TO CLICK SUBMIT!  DOUBLE CHECK SPELLING AND WORDING BEFORE SUBMITING.

ONLY 1 PHOTO IS REQUIRED PER BOX!

* Required
PLEASE ONLY CLICK SUBMIT ONCE AND WAIT A FEW SECONDS