1

Today's Date

 *

Today's Date

2

Date of proclamation start:

 *

Date of proclamation start

3

Date of proclamation end:

 *

Date of proclamation end

4

Proclaiming a (select one):

 *

Day

Week

Month

5

What are you proclaiming?  (ex: Earth Week)

 *

What are you proclaiming? (ex: Earth Week)

Organization address:

6

Sponsoring Organization Name

 *

Sponsoring Organization Name

7

Street:

 *

Street

Street

8

City:

 *

City

9

State:

 *

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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

10

Zip:

 *

Zip

Contact:

11

Name:

 *

Name

12

Title:

 *

Title

13

Phone:

 *

Phoneext.

14

Email:

 *

Email

15

Purpose of proclamation:

 *

Purpose of proclamation

16

Draft language of proclamation:

 *

Draft language of proclamation

17

Due to the nature of our community of four sister cities, organizations occasionally choose to do a joint proclamation.  Moorhead prepares these requests; however, the organization requesting the proclamation is responsible for contacting the other cities for approval, mayoral signatures, and seals.  Please select the city(ies) you want noted on your proclamation.

City of Moorhead, State of Minnesota

City of Dilworth, State of Minnesota

City of Fargo, State of North Dakota

City of West Fargo, State of North Dakota

18

When was the last time you have requested a proclamation from the City of Moorhead?

 *

Never

Last Year

2+ years

19

Notification preferences (select one):

 *

Call me when the proclamation is read and I will pick it up at Moorhead City Hall (3rd Floor), 500 Center Ave, Moorhead, MN.

Email me when the proclamation is read and I will pick it up at Moorhead City Hall (3rd Floor), 500 Center Ave, Moorhead, MN.

Mail the proclamation to the address listed above.

Present my proclamation at an upcoming City Council meeting. A City staff member will email available dates to the email address provided above.

Present my proclamation at my event or press conference.

20

Event/Press Conference Date:

Event/Press Conference Date

21

Event/Press Conference Time:

Event/Press Conference Time

22

Would you like the Mayor to read your proclamation at the event?

Yes

No

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

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