Required fields are marked with asterisks (*)

Celebration Details

Number of the Birthday/Anniversary/Years of Service

Date of birthday/anniversary or retirement:

Certificate required by date: (Please allow 2 weeks for processing.)

Who is receiving this certificate?

(Complete this section with the information of the person, people or business celebrating the milestone.)

First Name(s)

Last Name(s):

Company Name (if appropriate):

First Name

Last Name

Address:

City:

Province:

Postal Code:

Phone Number:

Email Address:

Special Requests / Notes for the Warden

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