Presidential Greetings

Note: Fields marked with an * are required.

First Name: *

Last Name: *

Street Address: *

Street Address Continued:

City: *

State: *

AL AK AZ AR CA CO CT DE DC FL GA HI ID IN IL IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code: *

Email: *

Telephone

Daytime Phone Number: *

Phone Type:

Voice VP TTD

Evening Phone Number: *

Phone Type:

Voice VP TTD

What are these options? Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option "Voice" is a standard audible telephone.

Honoree Information

First Name of Honoree: *

Last Name of Honoree: *

Street Address of Honoree: *

Honoree's City: *

State: *

AL AK AZ AR CA CO CT DE DC FL GA HI ID IN IL IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Honoree's ZIP Code: *

Exact Date of Occasion: *

Recognition Type: *

Birthday Anniversary Wedding

Please provide other necessary information:

Human Validation

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