Regis and Kelly
 
Note: All fields are required for submission.
ABOUT YOUR BEAUTIFUL BABY

Baby's Name:
Baby's Date of Birth (mm/dd/yy):
Date Picture was Taken (mm/dd/yy):
Nominator's Name:
Nominator's relation to child:
Hometown:
State/Province:
Daytime Telephone #:
Evening Telephone #:
Cell Phone #: (optional)
E-mail Address:


YOU MUST SUBMIT A PHOTO OF YOUR BABY WITH THIS QUESTIONNAIRE TO BE CONSIDERED.

To attach your file, click BROWSE above, locate the file on your computer in the pop-up dialog and push OPEN.

Remember:
  • Format your digital photo as a .JPG or .GIF.
  • The size of your formatted photo file should be 100K or smaller.
  • Photos will NOT be returned.