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2. A description and instructions on how to complete this form are included in the Proclamation Guidelines.
4. Proclamations are issued at no charge to individuals or groups and are eligible for presentation at a council meeting. All requests MUST be submitted at least two weeks prior to the date the proclamation will be presented or picked up. Presentations by the Mayor during a City Council meeting are placed on the agenda at the discretion of the Mayor and City Council.
6. Your contact information
8. First Name*
9. Last Name*
11. Address*
12. City / State / Zip*
14. Phone number*
15. Email*
17. Are you a nationally recognized non-profit organization?*

    1. Yes

    1. No
19. Proclamation Title *
    Specific title of what will be proclaimed, "Arbor Day" or "Small Cities Month"
21. Date of Proclamation*

    A specific day (July 4, 2014), a date range (July 3 - 12, 2014) or month (July)

23. Do you wish the proclamation to be presented at a Council Meeting?*

    1. Yes

    1. No, will schedule for pick-up
25. Provide the name of the individual(s) or group accepting the proclamation at the Council Meeting.*
    Enter "none" if scheduling for pick-up.
27. Please provide a minimum of 4-5 facts about the proclamation. Limit each key fact to 1-2 sentences. Please be clear and concise.
29. 1- Key Fact *
31. 2- Key Fact*
33. 3- Key Fact*
35. 4 - Key Fact (optional)
37. 5 - Key Fact (optional)
39. The City of Burleson retains the right to edit all proclamation text to reflect the City's vision, mission and goals. Proclamations must be picked up at City Hall, 141 W. Renfro, unless other arrangements have been made. If you have any questions about this form please feel free to contact the City Secretary's Office: 817-426-9681.
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

* indicates a required field