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Request an General Citation
Citation Requester's Information
First Name
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Last Name
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E-Mail
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Phone Number
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Home Address (Street, City, Zip)
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Date by which you would need the citation
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How would you like the citation delivered?
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Senator Agard will do her best to accommodate in-person citation requests, but this is dependent upon her schedule.
In-Person
Mail
If In-person citation is requested, please share the date, time, location and any other information about the citation event/delivery.
If selected mail, please provide the address you would like the citation sent to.
Information about Citation Recipient
Name as you would like it displayed on citation
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Constituent's Home Address (Street, City, Zipcode)
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Reason Citation is Being Requested
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Accomplishment
Anniversary
Award Recipient
Birthday
Career Milestone
Community Service
Honor Flight
Retirement
Other
Please describe in further detail the act or honor being cited, any important anecdotes of note, or anything else you would like Senator Agard to include in the citation.
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Brief Recipient Bio
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Date of Ceremony
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