Application to Request a Proclamation
Requests for City Proclamations should be submitted four weeks prior to the requested Council Meeting date. The City of La Pine
City Council meets the 2
and 4
Wednesday of each month unless otherwise noted. For specific meeting dates, please visit the City
Calendar on the City of La Pine website at
Topic & Purpose of Proclamation:
Individual, Agency or Organization Sponsoring the Proclamation:
Local Resident Attending Council Meeting to Receive Proclamation:
Name Phone
Note: There is a limit of two proclamations per City Council meeting and selection is made in the order requests are received. Please
indicate an alternative meeting date for the event the preferred date is unavailable. While the City does its best to recognize citizen
needs, we retain the right to decide if the proclamation will be issued or not.
Preferred City Council Meeting Date Requested:__________________________________________________
Alternate City Council Meeting Date:____________________________________________________________
Requested By-________________________________________________________________________________
Name Phone
_______________________________________________________________________________ __
Address Email
Date of Request:____________________________________
Please attach a draft copy of your one page proclamation to this application.
Return the completed form to:
City of La Pine, PO Box 2460, 16345 Sixth Street, La Pine, OR 97739 or via e-mail to
For Official Use Only:
PO BOX 2460 LA PINE, OR 97739
PHONE 541-536-1432 FAX 541-536-1462
Dennis Scott
Council Members
Stu Martinez
Don Greiner
Karen Ward
Connie Briese
Date Request Received_____________________________________________________________________
Approved____________________ Not Approved __________________ Applicant Noed______________
Date Proclaimed__________________________________________________________________________