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2. First Name*
3. Last Name*
5. Reply Email Address*
   What is the best email address to contact you?
7. Telephone Number*
   What is the best telephone number to contact you?
9. Title of Proclamation*
   What would you like to be proclaimed?
11. Proclamation Facts*
    Please provide a list of background information to include in the proclamation
13. Special Events
    Will there be any special events for what is being proclaimed? If so, please list the event name and date.
15. Requested Signing Date*
    Requested Signing Date

    Requested Signing Date
    What date are you requesting for the proclamation to be signed?
17. Thank You
    Thank you for submitting your request. The Hinesville Public Relations Manager will contact you soon to confirm a signing date.
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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit Submit and Print

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