 | ||||
Retiree's full name: *
City and state of retiree's current residence:
Retiree's birthday or age:
Is the retiree a friend, co-worker, or relative? *
Any nicknames for retiree:
Retiree's relationship with other employees:
If married, do you want spouse mentioned in poem?
Position in company:
Work related experiences you would like to share:
Funny stories or anecdotes you would like to share:
Do you want to express appreciation for the number of years you spent working together and if so, how?
Activities/hobbies retiree enjoys doing:
Special words you would like to say to the retiree and your hopes for his/her future: *
Life experiences you would like to share:
Names, ages, and sexes of your fiancee's children, if applicable:
Is retiree married and if so, spouse's name?
Additional comments, notes or instructions that you would like our writers to consider in creating your gift of poetry: *
Important milestones in retiree's life or work:
Specific instances where retiree made a difference in the workplace:
"Inside" jokes to share that retiree would appreciate:
Number of years retiree worked for this company:
How has this person affected/impacted your life?
Your relationship to
poetry recipient: *
Your full name: *
Your mailing address: *
Daytime phone number and best time to call: *
Evening phone number and best time to call: *
Special instructions or comments and date poem is needed: *
* Denotes required field.
Provide us with the requested information about yourself.
Then complete the poetry information request form below as you are able. Remember, the more detailed the information you provide, the more personal and unique the gift.
Your email address: *
Name of company retiring from: *
* Denotes required field
Physical traits of retiree (e.g., tall,
hair color, eye color, strong, handsome,
cute, intelligent, witty, talented, etc.): *
Character traits of retiree (e.g., supportive, loving, kind, thoughtful, caring,
hard worker, nurturing, unselfish, etc.): *
"special words for special people"
