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2. First Name*
3. Last Name*
4. Organization
6. Email *
7. Phone Number*
9. Address*
11. City*
12. State*
13. Zip Code*
17. Person, group, or organization being recognized*
19. Why is this person, achievement, or event extraordinary?*
21. Body of Certificate of Recognition*
    The body of the certificate is limited to 130 words. Please enter your desired wording and the information you would like included in the certificate.
23. Attach a File
    If you have a document with the information or desired wording, please upload it here.
27. Would you like to pick up this certificate from City Hall or would you like a copy emailed to you? *
    -- Select One --EmailPick up
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field