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Proclamation Request Form

2. Name

3. Email Address

5. Address

7. City

8. State

9. Zip Code

11. Phone Number

12. Fax Number

16. Purpose of Proclamation

    Please select the reason this proclamation is being requested.

    1. Award/ Achievement
    2. Dedication of Day/ Month
    3. In Honor
    4. Awareness
    5. Eagle Scout/ Gold Award
    6. Other
17. Other

21. Proclamation Details

23. Proclamation For:

25. Reason for Proclamation

29. Details to be Included in Proclamation

31. Personal Information

33. History

35. Prior Achievements

37. Community Involvement

39. Other

43. Council Involvement

45. Event Information

    1. I request Mayor or Council to attend and present the Proclamation at my event.
    2. I request this proclamation be presented at a Council Meeting.

47. Date

48. Time

49. Location

51. Date of Council Meeting

Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field