There is no charge for publication of this announcement, but there is a $10 charge if you wish to have a photograph printed with the announcement (make check payable to W-R Independent). If you wish to have the photo returned, please include a stamped, self-addressed envelope of sufficient size. Mail this form (and your check & photo, if any) to W-R Independent, P.O. Box 242, Wood-Ridge, NJ 07075-0242, or place it in the dropbox in the foyer of 210 Hackensack Street.

If you wish to have copies of the edition in which your announcement appears, indicate at bottom of this form how many copies you need and enclose $.50 per copy when submitting your announcement. (you can add this to your $10 payment if a photo is enclosed).

Prospective Bride's Name:_________________________________________________________________________________

Presently residing in:_______________________________________________________________________________________

Parents' name(s)/town(s) of residence:_________________________________________________________________________

School(s) attended/being attended/year(s) of graduation/degree(s) received/field of study:________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Place of Employment (if any)/Job Title:_________________________________________________________________________

_________________________________________________________________________________________________________

Prospective Groom's Name:________________________________________________________________________________

Presently Residing in:______________________________________________________________________________________

Parents' name(s)/town(s) of residence:_________________________________________________________________________

School(s) attended/being attended/year(s) of graduation/degree(s) received/field of study:________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Place of Employment (if any)/Job Title:_________________________________________________________________________

_________________________________________________________________________________________________________

Planned Date & Location (if any) of Wedding:____________________________________________________________________

Check if applicable: I am enclosing $10 for a photo ___, and/or $.50 per copy for ___ copies of edition in which this announcement is published at $.50 per copy (total for copies: $________. Total Amount Enclosed (including photo charge): $________