Proclamation Request Form

Policy Number: B25

First Name

Last Name

Organization Name

Mailing Address

City or Town

Postal Code

Business Phone

Home Phone

Fax Number

E-mail address

Dates of Proclamation (please check and insert dates):

Day(s)

Week

Month

Purpose of Proclamation (please check all that apply):

Civic Promotions

Charitable Fundraising Campaign

Special Honour of Individual or Organization

Public Awareness Campaign

Arts and Culture Celebration

Other

Has the same/similar proclamation been requested of the County of Grande Prairie in past years?

Yes

No - New Request

As part of this proclamation, will there be any special initiatives or events planned in the County of Grande Prairie?

Yes

No

Does this Proclamation require the Reeve or Council to attend an event?

Yes

No

Draft wording for Proclamation: You must provide draft wording for the proclamation and attach it to the Proclamation request Form

Upload document containing draft wording for proclamation.

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Description of the Organization: please include a brief description and any other relevant information related to your request.

Please upload any additional information/documentation that you wish to submit with this application.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Applicant Authorization:

I understand that checking this box confirms that I do hereby declare that all of the information given above is true to the best of my knowledge and belief.

Applicant Signature: A typed name on an electronically submitted form constitutes a signature for the purposes of this application.

Protection of Privacy - Personal information collected on this form will be used for the purpose of administering the program or service for which the information is collected. This collection is authorized by Section 4(c) of the Protection of Privacy Act and the information collected will also be subject to the Access to Information Act. For questions about this collection of personal information by the County of Grande Prairie, contact the Access and Privacy Officer at AccessPrivacy@countygp.ab.ca or call 780-532-9722