Questionnaire

For Memories Around Us to produce this personalized poem, we need answers to the following questions. Please note that you will be presented with the opportunity to edit your answers prior to final submission.  Once you have completed the questionnaire, you will be presented with the order page to finalize your frame and matte selections. Should you have any questions, please contact us.  Click here to down load a printable form.

1:
 I am ordering a... Wedding Poem          Anniversary Poem
2:
 What is/was the date of the wedding?
 /    /  
3:
What is the GROOM's FIRST & LAST NAME
given at birth?
4:
Is there an ABBREVIATED NAME the groom prefers in place of his birth name? For example, "Joe" instead of "Joseph".
    
5:
What is the GROOM'S BIRTH DATE?
 /    /  
6:
A.)  What is the Groom's Father's Name?
B.)  What is the Groom's Mother's Name ?
7:
In what town/city AND/OR state/country was the groom raised?
,
B.) Would you consider the groom to be        more of a “country” boy or “city” boy?
City Boy          Country Boy
8:
What is the BRIDE'S FIRST & LAST NAME
given at birth?
B.) If the bride’s last name is different from her birth name, what last name should be used in this poem?
9:
Is there an ABBREVIATED NAME the bride prefers in place of her birth name? For example "Betsy" instead of "Elizabeth" .
    
10:
What is the BRIDE'S BIRTH DATE?
 /    /  
11:
A.)  What is the Bride's Father's Name?
 
B.)  What is the Bride's Mother's Name?
12:
In what town/city AND/OR state/country was the bride raised?
,
B.) Would you consider the bride to be        more of a “country” girl or “city” girl?
City Girl          Country Girl
13:
What MONTH & YEAR did the bride and groom meet for the first time?
,
14:
What MONTH & YEAR did the bride and groom experience their initial sparks toward one another?  Please note this typically occurs before the first date.
,
15:
Please describe the EVENT and DETAILS where the initial sparks took place.  Please note this typically occurs before the first date.
16:
From the moment the initial sparks took place, approximately how many DAYS, WEEKS, MONTHS, or even YEARS passed before the bride and groom began to date one another?
DAYS:
WEEKS:
MONTHS:
YEARS:
17:
In what month and year was the couple engaged?
, 
18:
Enter your name as it will appear on the order.
19:
Enter your phone number as it will appear on the order (required).
Example Format: 1234567890 (no dashes/parenthesis)
20:
Enter your Email Address (required).
Example Format: you@somewhere.com
21:
Please enter the first and last name of the person who referred you to our website:

 



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Memories Around Us  •  1205 Main St.  •  Ferdinand, IN 47532  •  812-367-0504