Proclamation Request Form
Please fill this form with respect to the guidelines below. If mailing or delivering in person, please select the "Print Form" button at the bottom of the form.
Requirements
Requests must be submitted at least 30 days prior to the proposed date of issuance.
Requestors must be based in the Town of Occoquan, Prince William County, or Fairfax County.
The length of time requested for a proclamation must be no less than one day and no more than 31 days.
Considerations
Proclamations affecting a broad group of people should attempt to honor local individuals or a specific organization with specific ties to the Town of Occoquan.
Proclamations should not endorse political or religious views or any controversial issues.
Proclamations should not promote commercial enterprises or specific products.
The Town may limit the number of proclamations issued for the same or similar causes within a calendar year.
Multiple requests by the same organization will not be honored within the same calendar year.
Submission requests are one-time requests and do not automatically renew.
Contact Information
Full Name
*
First Name
Last Name
Affiliated Organization
If an individual with no affiliation, please respond "N/A".
Phone Number
*
Please enter a valid phone number.
E-mail
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Proclamation Information
Proclamation Title
*
Name of the day, week or month to be proclaimed.
Date to Be Proclaimed - Start Date
*
-
Month
-
Day
Year
Date to Be Proclaimed - End Date
*
-
Month
-
Day
Year
If for one day, enter same date as above.
Background and Rationale for Proclamation
*
Have you received a proclamation from the Town in the past calendar year?
*
Yes
No
How would you like the proclamation to be presented?
*
Presentation at Town Council meeting
Presentation at your special event
Private delivery - via mail
Private delivery - in person pick up
Proposed Proclamation Language
Please provide 5 to 10 "Whereas" clauses. Note: the proclamation language submitted may be edited, rewritten, or rejected. Not all clauses may be included in the final version of the document. Please reference the sample below for help.
Sample Proclamation
Whereas,
*
Whereas,
*
Whereas,
*
Whereas,
*
Whereas,
*
Whereas,
Whereas,
Whereas,
Whereas,
Whereas,
Please verify that you are human
*
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Submit
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