| CONTACT PERSON INFORMATION |
|---|
* Name of Contact Person
|
* Street Address
|
* City
|
*State
|
*Zip Code
|
* Phone #
|
Additional Phone #
|
Email Address
|
| PROCLAMATION / CERTIFICATE INFORMATION |
|---|
* Name of Individual, Group or Organization
|
* Name of Title of Event
|
* Date of Event
|
* Do you request a City Representative for Event?
No
Yes |
* How will you get the Proclamation / Certificate?
Will pick up at Mayor's Office
Please mail to above address |
* Which one are you requesting?
Certificate
Proclamation |
* Info to be listed on Proclamation / Certificate
(What you want your proclamation / certificate to say. A proclamation must have enough information to make four points.)
|
| ADDITIONAL INFORMATION |
|---|
Additional Comments
|
| * Items marked with an asterisk (*) are required to be filled on this form. |