Thank you for your interest in Mercy Stork Affair. Please complete the following information to pre-register and be eligible for prize drawings.

You reserve the right to revoke your permission for Mercy to use this information by calling (515) 247-3050.

1. How did you hear about Mercy Stork Affair?

2. Are you currently expecting?

3. If you answered yes to the above question, what is your expected due date?

Due Date:
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4. If currently expecting, where will you be delivering?

5. May we share your name with vendors who donated prizes?

6. Please provide your contact information.

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