Proclamation Requestor Form

Home Get Involved Advocacy Proclamation Requestor Form


*indicates required field
Proclamation Information

Affiliate/Community Advocate Name*

Municipality Name*

State*

Municipality type*

Who sponsored your proclamation? (i.e. Mayor John Doe)*


Requestor Information

First Name*

Last Name*

Address

City

State

Zip Code

Email*

Is this the first time you requested a proclamation acknowledging either November Awareness or World Pancreatic Cancer Day?*


Have you previously volunteered with the Pancreatic Cancer Action Network?*


If you answered “Yes” to the question above, how have you interacted with the organization previously?





Please let us know if you have any additional comments about your experience obtaining this proclamation.



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