Join the NBC NE Birthday Club!

$req.param("responded")

Come in and celebrate!

Please fill out the form below to celebrate that special someone's birthday!

If you have a photo or video you would like to include please email it to desk@nbcneb.com.

1.Contact Information:
Name of Birthday Individual*
Date of Birthday*
Their Age
Their Town*
Your Email*
2.Birthday Individual(s) Address:
Street*
City*
State*
Zip Code*
3.Your Birthday Greeting:
4.Please enter your date of birth.
Month* Day* Year*

5.Terms and Conditions
I have read, understand, and agree to the Website usage agreement and privacy policy.
* represents required fields

Moms Everyday - Central Nebraska