Would YOUR CHILD like to hear their name on 91.1 WIBI on THEIR BIRTHDAY? They can, if you sign them up for the 91.1 WIBI KID'S CLUB. The birthday greetings will be announced weekdays during The Morning Show with Lori & Jeremiah at approximately 7:20 a.m. Birthdays that fall on the weekend will be mentioned on Saturday morning. The 91.1 WIBI KID'S CLUB is for children through age 12.

This form needs to be filled out by an adult & must be submitted 2 weeks before your birthday-Please fill out the whole form or else your birthday will not be mentioned-Thanks!

Child's Name (First & Last)


Birthday
Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Name of School


Grade in School

Parent's Name

Street Address

City

State

Zip Code

Phone Number (include area code)

E-mail Address

91.1 WIBI Privacy Statement: All information submitted is confidential and will not be given or shared with anyone.