1

Name/Organization Requesting Recognition

 *

Name/Organization Requesting Recognition

2

Physical Address of Requester/Organization 

 *

Physical Address of Requester/Organization

3

Mailing Address of Requester/Organization (if different from physical address)

Mailing Address of Requester/Organization (if different from physical address)

4

Email

 *

Email

5

Daytime Telephone

 *

Daytime Telephoneext.

6

Type of Request

 *

Type of Request

Letter of Recognition

Proclamation

Certificate

7

Method of Recognition

 *

Method of Recognition

Via Email

Organization Event

Via US Mail

Town Council Meeting Agenda

8

Description of Recognition 

 *

Description of Recognition

9

Date Requested by (Allow three weeks)

 *

Date Requested by (Allow three weeks)

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

Page 1 / 1