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(*) Indicates Response Required
* What is your name
 
* What is your e-mail address
 
* Who do you want the poem written for
 
* Why do you want the poem written
 
* What style of poem would you prefer (happy, sad, romantic etc.)
 
* Please choose which package you would prefer
 
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  What are the key messages you would like to send
 
  Do you have any funny, sad, happy, embarrassing or otherwise memorable moments that you would like to share
 
  Do you have any other comments or thoughts
 
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