Requester Information
First Name
*
Last Name
*
Phone
*
-
-
Email
*
Recipient Information
Is the scroll being requested for an individual or organization?
*
Select One
Individual
Organization
Organization Name
*
First Name
*
Last Name
*
Occasion Type
*
Select One
Contributions to the local community
Birthday
Wedding Anniversary
Organization Anniversary
Business Anniversary
Retirement
Occasion Date
*
-
-
Birthday Years
*
Select One
80
85
90
95
100
105
Wedding Anniversary Years
*
Select One
40
50
60
70
80
Organization Anniversary Years
*
Select One
10
15
20
25
30
35
40
45
50
Business Anniversary Years
*
Select One
10
20
30
40
50
Years of Service
*
Key Messages to Include
*
Please be as detailed as possible
Would you like the Mayor to Co-Sign the Scroll?
*
A
Yes
B
No
How would you like to receive the scroll?
*
A
Presented In-Person
B
Picked up
C
Mailed
This option is subject to my availability. Please fill out the Event Invitation Form:
https://www.chrismoise.ca/eventinvite
You will receive an email once your scroll is ready for pickup at Toronto City Hall (100 Queen Street West).
Street Address
*
Unit/Suite #
*
City
*
Province
*
Postal Code
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