All questions must be answered, unless marked (optional). Please allow at least 3 business days for processing. Birthdays that are uploaded on the actual birthday are unlikely to be broadcast. Submissions dated for weekends will air on Fridays and Mondays. Photos with excessive text or alterations will be edited.

First

Last

(Please enter your name, if your entry is for a child.)

Email*

Phone*

Birthday*

Age (On Birthday)*

Select Photo*

I agree to allow my submitted images to be used online and on-air by WXIX and to further marketing communications from WXIX.*

Please submit at least 48 hours in advance to allow processing time, thank you!

Got a special someone with a birthday coming up? Sign them up for our FOX19 NOW Birthday Club!