2015 Mayors Day of Recognition for National Service Online Form

Thank you for participating in the 2015 Mayors Day of Recognition for National Service! We greatly appreciate your support. Please fill in the online pledge form below. The only information that will be displayed on our website will be the name, title, city (or county) and state. The other information will help us communicate with you about resources and opportunities to highlight your activities.   

 

What is your mayor or county executive's first name?
What is your mayor or county executive's last name?
What is your exact title (Mayor, County Mayor, County Supervisor, etc)?
What is your street address?
What is your city/jurisdiction?
What is your state?
What is your zip code?
What is the first name of the person submitting this form?
What is the last name of the person submitting this form?
What is the email of the person submitting this form?
What is the phone number of the person submitting this form?
What is the approximate population of your jurisdiction? (Only use numbers)
What is the contact person's first name?
What is the contact person's last name?
Valid E-mail for the contact person.
Valid phone number for the contact person.
What is your media contact person's first name?
Please tell us the media contact's last name.
Valid E-mail for your media contact person.
Valid phone number for your media contact person.
What planned activities are in the works?
Back to Top