Required fields are marked with asterisks (*)

Birthday and Wedding Anniversary Greetings / Certificate - Request Form

Personal information in relation to this process is collected under the authority outlined in the Municipal Freedom of Information and Protection of Privacy Act. This information will be used only for the purpose for which it is intended. If you have any questions regarding this collection of personal information, you can contact the Freedom of Information and Privacy Coordinator, who can be reached through the Clerk’s Office at (519) 740-4680. Ext 4583.

Certificate Information

Salutation (Mr, Mrs, Ms, Dr, etc.)

Name to appear on Birthday Greeting or the Names of the Wedding Anniversary Couple (as it will appear on card or certificate)

Birthday or Anniversary number (ie: 50th)

Actual Birthdate or Wedding Date

Contact Information

Contact Name

Phone Number

Contact Address

City

Postal Code

Date of any Special Celebration Party

Date of Request

Any Special Requests

Certificate Delivery Information

(Where certificate should be sent)

Name

Address

City

Postal Code

PLEASE NOTE

For certificates, please allow 2-3 weeks for delivery. If you wish your certificate presented at your event by the Mayor or Ward Councillor please allow for 4 weeks’ notice (subject to schedule availability).

For further information, please contact the Mayor's Office, (519) 740-4517, Ext. 4619 or Fax: (519) 740-4663.