Required fields are marked with asterisks (*)

Community Recognition Certificate Request Form

Thank you for your nomination! We look forward to reading about your request for the Municipality of South Bruce Recognition Certificate.

This form is to recognize special occassions such as Business Anniversaries, New Businesses, Business Open House, significant wedding anniversaries, Business Retirement, community volunteer etc.

All fields marked with an * are required to submit the form.

Certificate Nomination Submitted By

Name

Address

City

Province

Postal Code

Phone

Cell

Email Address

Is this request for a Municipality of South Bruce resident, community organization or business owner?

Yes

Information About Your Nominee for a Community Recognition Certificate

Contact Name

What do you want this resident, business or community group recognized for?

Community Volunteer

Business Anniversary

New Business/Open House

Business Retirement

Business Recognition Award

Wedding Anniversary

Other

Please provide details related to this recognition award. ie. Why, # of years, how they have contributed to the community. etc.

Business or Resident's Address