Recognition Choice Form

Corporation of the Town of Kirkland Lake

First and Last Name *

Phone Number *

(and extension if applicable)

Email Address *

Please select level of Recognition *

Volunteer

5 years

10 years

15 years

20 years

25 years

30 years

35 years

Retirement

Deadline to Submit

Deadline to Submit

Please be sure to submit your Recognition Choice no later than November 15th.

*

Send me a copy of my responses

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