America250AL - Semiquin City • American Village Citizenship Trust

*required entry

Full Name *

Last Name *

Title/Role *

Phone Number *

Email Address *

City or Municipality Name *

County *

City or Municipality Mayor's Full Name *

Mayor's approval *

I confirm that the Mayor is aware of this application and has approved this request.

City or Municipality Shipping Address (no PO Box) *

City or Municipality Mailing City *

City or Municipality Mailing State *

City or Municipality Zip Code *

Commemorative Flag Request (3' x 5' flag, fitted for a flag pole) *

Yes, we would like to receive a commemorative America250Alabama flag

No, we do not want to receive a commemorative America250Alabama flag

1. Incorporate America’s heritage in all semiquincentennial programs, public events and legacy projects.

We agree to the above: *

Yes

2. Ensure that our city/municipality semiquincentennial programs, events and projects are non partisan and inclusive.

We agree to the above: *

Yes

3. Ensure that our city/municipality semiquincentennial programs, events and projects educate, engage and unite our community.

We agree to the above: *

Yes