Texas Health Resources
Birthday Buddies Registration



Please complete and submit this form to receive Birthday Buddies information to send to your child's party guests.

A RED asterisk (*) denotes required fields. After completing all fields click on the Submit button.



Child's Last Name: *
 
 
Child's First Name: *
 
 
Parent First Name: *
 
 
Parent Last Name: *
 
 
Street: *
 
 
Street 2:
 
City: *
State/Province: *
Zip: *
 
Phone Number: *
 
 
E-mail:*
 
 
Child's Birthdate:
 
 
How many guests are you inviting? *
 
 
What is the date of your party? *
 
 
Is your child currently a Birthday Buddy?
 
Which Texas Health NICU would you like your donations to benefit? *






 
Where did you hear about Birthday Buddies? *

 

Please enter authentication challenge characters below and click Submit button only once.

 
Texas Health Foundation Birthday Buddies
612 E. Lamar Blvd., Suite 300
Arlington, Texas 76011
682-236-5234
682-236-5201 - Fax
www.texashealth.org
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