Town of Whitby Proclamation Request

Instructions:

Proclamations are to be submitted at least four weeks in advance of an event
Requests will be reviewed by the Town Clerk for eligibility
Proclamations will be issued by the Mayor upon approval by Town Council

Name of Individual, Organization or Community Group

Name

Mailing address (street number, street name, unit / apt)

City

Postal Code

Email Address

Business Phone No.

Home Phone No. (Contact)

Description of Organization (mandate/history or other relevant information)

Date of Proclamation

Purpose of Proclamation

How does this request meet the criteria for evaluation of Proclamations

Would you like to attach supporting information for this proclamation request?

Yes

Evaluation criteria available through CA 120 Issuance of Proclamations

By putting my initials below, I hereby certify that the information contained in this application form is accurate

Initials

Date

The personal information on this form is collected under the authority of the Municipal Act. The information is used to evaluate the request for a proclamation. Questions about this collection can be directed to the Town Clerk, 575 Rossland Road East, Whitby, ON, L1N 2M8 or by telephone to 905-430-4315.

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Town of Whitby Proclamation Request

Name of Individual, Organization or Community Group