Proclamation Request Form PROCLAMATION REQUEST FORM Contact Name: * Contact Name: First First Last Last Address: Address: Address: Address: City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone: * Alt. Phone Number: Email: * Organization (if applicable): Date(s) of Proclamation Proclamation Date: plus1 Add minus1 Remove Requesting to proclaim a: Day Week Month Is this a request to reissue a proclamation from a previous year(s)? YES NO If so, what was the date of the proclamation? Delivery of Proclamation: Please Mail Pickup Council Meeting Briefly describe the purpose you would like a proclamation to serve or the message that you would like to convey: Requests must include draft language and/or background information that will be used to prepare the proclamation. Include a short statement (not less than four “WHEREAS” paragraphs) describing the reason for the proclamation (i.e. anniversary, commendable public service, etc.). Please upload a draft document with the requested information with this form: Drop a file here or click to upload Choose File Maximum file size: 209.72MB If you are human, leave this field blank. Submit
