Celebration Registry We are excited to be a part of the celebration of your life!Today's DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Your Name*Telephone Number*Email* Your Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code SECONDARY CONTACT - Who Else Can Pick Up Your Gift Certificate?What is the best way to contact your secondary contact? Mail Email Cell Phone Secondary Contact Name First Last Secondary Contact PhoneSecondary Contact Email "CELEBRATION REGISTRY' DETAILSWhen Do You Want To Start Your 30 Day Sign Up Period? When Do You Want To Pickup The Gift Certificate? Who will pickup the merchandise/gift certificate. ONLY ONE PERSON CAN BE DESIGNATED First Last How are you going to encourage people to come in to sign your book?Have you ever used our "Celebration Registry" in the past? If so, when? Yes No How will you encourage others to sign your book? Personal Website Special Website / Landing Page Facebook Twitter Special Email Campaign Is there anything else you would like to share about your strategy?Do we have permission to use your name and your special life moment on our website, blog and social media platforms? Yes No Do we have permission to use any photos you give us on our website, blog and our various social medial platforms? Yes No AGREEMENTBy submitting this form for the Mucklow's Fine Jewelry "Celebration Registry" program you are confirming that you are 18 years old or older and that the merchandise / gift certificates you receive will not be resold. Call Mucklow's Fine Jewelry to confirm we received your form.Our business hours are: Tuesday through Friday from 10:00 am to 5:30 pm - Saturday from 10:00 am to 4:00 pm - Closed Sunday & Monday - 770-486-3400
