Certificate Request | Marc Dalton

Information for the person submitting the request and for the celebrant(s) is required.

Requestor Information:

First Name*

Last Name*

E-mail*

Phone Number*

Name(s) on certificate*

Postal Code*

Phone Number*

Occasion* BirthdayAnniversaryOther

If the certificate is for a birthday or anniversary, how many years are you celebrating?

Number of years:

Date of Birthday/Anniversary/Other*

Would you also like to request: King Certificate (for 100+ year birthdays and 60+ year anniversaries)Governor General Certificate (for 90+ year birthdays and 50+ year anniversaries)Prime Minister Certificate (for 65+ birthdays (at 5-year intervals) and 25+ anniversaries (at 5-year intervals))Leader of the Official Opposition Certificate (for 65+ birthdays (at 5-year intervals) and 25+ anniversaries (at 5-year intervals))

Details:

How would you like to receive the certificate?* Pick it up from my constituency officeMail to RequestorMail to Celebrant