Proclamation Update & Submission Form
Please complete the following form in order to update U.S. Pain regarding your Awareness Month Proclamation request.
Your Last Name
Your First Name
Your Preferred Email
Your Role with U.S. Pain (select ALL that apply)
State where proclamation was requested
City where proclamation was requested (if applicable)
Date you initially submitted your proclamation request - if you don't remember, please put an estimated date
Comments: Please provide details regarding any special instructions or feedback you received from the government office during this process.
Date your proclamation was marked as pending, approved, received, or denied
Picture of your proclamation, image of you holding your proclamation, or both
Date you mailed or intend to mail the hard copy of your proclamation to U.S. Pain
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