Instructions: Please fill out the information below and submit to the Cecil County Council Office. Request should be submitted at least three weeks prior to the presentation date to provide enough time to schedule for the Council member(s)

1

Type of request you are applying for:

Type of request you are applying for:

Proclamation

Certificate of Recognition/Achievement

2

Where will the presentation be held

Where will the presentation be held

County Administration Building at a Council Meeting

Other Location

If other location, requested presentation location:

If other location, requested time of event:

Requested Presentaion Date:

3

Requested By:

 *

Requested By:

First & Last Name	Organization
Address	City
State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip Code
Phoneext.	Email

4

Information for recognition:

 *

Information for recognition:

First & Last Name	Organization
Address	City
State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip Code
Phoneext.	Email

5

Please provide the details for the request, and/or attach information to this request below.

 *

Please provide the details for the request, and/or attach information to this request below.

Details

Attach any needed information to this request here. Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

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

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