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2. Name of recipient(s)*
   Name(s) on certificate will appear exactly as specified above
4. Type of Event*

   1. Wedding Anniversary

   1. Birthday
6. Years/Age*
7. Date of Event*
9. Contact Information:
11. First Name
12. Last Name
14. Address1
16. Address2
18. City
19. Province
20. Postal Code
22. Phone Number*
24. Email
26. Delivery of Certificate

    1. I would like to be notified when the certificate is available for pick-up.
    2. I would like the certificate to be sent by regular mail to the address provided above.
28. Please allow 10 business days to process. For more information contact our office at 403-443-5541.
    The personal information on this form is being collected for the purpose of creating a special certificate. This information is collected under the authority of Section 33(c) of the Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information can be directed to the FOIP Coordinator at 403-443-5541.
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30. Submit

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