Birthday Submission

Birthday Submission Form

*All fields are required.
First Name: *
Last Name: *
Birth Date:  (YYYY-MM-DD) *
Age: *
Email Address: *
Phone Number: *
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Your registration information is for the use of WKTN-FM only. We collect information in order to keep you informed of contests and events sponsored or promoted by WKTN-FM. WKTN-FM will not sell, rent or in any way distribute personal information supplied to us by you. The information you provide us stays with WKTN-FM only.

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