Below is a list of prizes the Mom of the Month will win:
ParkHill Jewelers- $50.00 gift certificate
Just for Kids Furniture- $100.00 gift certificate
Neffsville Flower Shop- a $50.00 arrangement sent to the Mom's residence
Domino's Pizza- Free Large Pizza coupons
Name of Mother:
Mother's e-mail:
Mother's phone number:
Mother's employment (check the box that applies):
Self employed Mom
Stay-at-home Mom
Professional Mom
Please answer the following questions:
Tell us about Mom's family:
Age(s) of child or children:
What are Mom's hobbies and interests?
What are the two best things about this mom?
What are Mom's most recent projects, special events, or achievements?
Please provide your contact information: