2024 Donated Online Plate Orders

2024 Online Plate Order

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List child's name and birth stats as you want them displayed on the plate. Please put NA if you do not have some of the baby information.

Hospital Delivered: OO

Bereavement Nurse: OO

How did you hear about us: OO *

Please be specific.

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Parent First Name *

Parent Last Name *

Email *

NOTE: You will receive a confirmation email of your order. Please confirm your order is correct. Any mistakes in the information provided will require a $50 charge to create a new plate.

Parent Phone *

Parent Phone 2

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country

Secure Payment

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