The Times And Democrat Newspaper Birth Announcement Form (Page 2 of 2) in pdf

The Times And Democrat Newspaper Birth Announcement Form Page 2

Indemnification Form

I hereby indemnify The Times and Democrat of any liability resulting from the use of information regarding:

_______________________________________________________________________________________________

to appear in

The Times and Democrat newspaper or the T&D Shoppers Extra newspaper

or the newspaper’ s web site, .

Date Ad To Appear

Signed

Contact Person Form

Contact Person: __________________________________________________________________________________

Daytime Telephone: Work:__________________________________ Home: ________________________________

Fax:___________________________________ Email: ___________________________________________________

Credit Card #:______________________________________________ Expires: _______________________________

Home Address:

(Not for publication)

____________________________________________

_____________________________________________

____________________________________________

Signature of wife/husband or family member

____________________________________________

_____________________________________________

The Times and Democrat

The Times And Democrat Newspaper Birth Announcement Form Page 2