Which certificate would you like to request?

Milestone birthday
    (75 years or more, in increments of 5 years)

Wedding anniversary
     (25 years or more, in increments of 5 years)

Special honours
     (recognition at a provincial, national or international level)

Other (please specify)
     

Correction

Celebrant details:

If the certificate request is for a wedding or anniversary, please fill in information for the first person and the second person in this section.

Salutation (first person):

Mr.    Mrs.    Ms.    Other
 

First name:  

Last name: 

Salutation (second person):

Mr.    Mrs.    Ms.    Other
 

First name:  

Last name: 

Organization name: (if sending to an organization, rather than an individual)

 

Address Line 1:

Address Line 2:

City:

Province:

Postal Code:

Contact details:

Name:

Daytime telephone:

Email:

Mailing details:

Mail to
Celebrant   Other (if other, please complete fields below)

I will pick up from the City of Pickering, Customer Care Centre

Salutation:
Mr.   Mrs.   Ms.   Other
 

First name(s):  

Last name(s): 

Organization name: (if sending to an organization, rather than an individual)
 

Address Line 1:

Address Line 2:

City:

Province:

Postal Code: