Sign Up for WYMT's A Rich Full Life

If you know someone 75 years or older, or someone married 50 years or more who lives in eastern Kentucky,
Fill out the form below or download the form here to print it out and mail in.

To allow adequate production time, birthday or anniversary announcements must be submitted 3 weeks prior to the week of the birthday or anniversary.

If you would like to send in a picture to go along with you Rich Full Life submission please either e-mail it to this address.

Rich.FullLife@wymtnews.com

Mail it along with the form to

A Rich Full Life
c/o WYMT-TV
P.O. Box 1299
Hazard, KY 41702

Please include the person information in your mailing and your return address if you would like to have your photo returned to you.

1.Anniversary Date:

Month		Day		Year

2.Birthday Date:

Month		Day		Year

3.Information For The Person or Couple:

First Name*		M.I.		Last Name*

Email Address*		Daytime Phone		Evening Phone

4.Address For Ther Person or Couple:

Street Line 1*

Street Line 2

City*

State*

Zip Code*

5.Your Name:

6.Please enter your date of birth.

Month*		Day*		Year*


	7.Terms and Conditions

	YES, I have read, understand, and agree to the Web site usage agreement and privacy policy.


	* represents required fields Children under the age of 13 may not submit this form.

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