SpotOn With Vernon Birthday Entry Form
I recognize you as someone I should recognize on your birthday during my radio programme, 'SpotOn With Vernon Derby' to be aired on Omega KLAS FM as of September 2023. Please enter the information requested on the form, and I will add you to my birthday list.

Please visit MY BLOG after submitting this form.
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E-postadresse *
Prefix (Hon. Dr. for example)?
Your first name? *
Your surname? *
Suffix (OD and PhD for example)?
Cell phone?
Profession?
Say a few words about yourself (Educational institutions attended, hobbies and your areas of interest). *
Your birth month (99)? *
Birthday (99)? *
Remarks?
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Select 'N' which is the only option.
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