25 Years of Service Awards Form

Contact Information:

List the name of the person who will be responsible for receiving information, the certificates and lapel pins. This person will be our contact should changes be necessary.

First Name *

Last Name *

Title *

Postal Address: *

City *

State *

Postal Code *

Business Phone *

Email Address *

Please choose one:

The municipality will present the recipients with their certificate.

We prefer that an OML board member or staff member make the presentation.

If you would like an OML board member or staff member to participate in the presentation, please indicate three of your preferred dates and times:

If an OML board member or staff member makes the presentation, please include the presentation address (if different from above)

Nominee Information:

If you would rather upload a file with your recipients information than entering it below, please upload the file here.

I hereby certify that the following individuals have completed 25 years, or more, of service as an official and/or employee of the *

City

Town

of: Municipality Name *

Note: You can add multiple recipients to this form by clicking the plus sign next to each field below.

Full Name

Present Title

Municipal Government Starting Date of Service

If you have any questions please contact April Bradbury via E-mail: april@oml.org

(PLEASE NOTE: If you don't receive a confirmation email - please contact April Bradbury at OML or call (405) 528-7515 or (800) 324-6651)