Developmental Newsletter Subscription Form

Print and complete, mail with your subscription payment of $30 to receive eleven issues of our Baby TALK Developmental Newsletters. Mail to: Baby TALK, 500 East Lake Shore Drive, Decatur, IL 62521.

Parent first and last name: _____________________________________________________

Address: ___________________________________________________________________

City, State, ZIP: _____________________________________________________________

Phone: _____________________________ Email: _________________________________

Child's name: _______________________________________________________________

Child's date of birth:    Month:_______ Day: _______  Year: _______