Request a Parliamentary Celebratory Message 
Fill out the form below to request a special mention in the NSW Parliament for birthdays or wedding anniversaries of friends or loved ones. This address will appear in the official Parliamentary Hansard, and a copy will also be sent to the recipient. 

Please note the recipient must live in Ryde and messages must not contain inappropriate language. 

While I will do my best to deliver your message in full, there may be some modifications due to time restrictions or Parliamentary practice and procedure on the day. 

Authorised by Jordan Lane MP and funded using parliamentary entitlements. 
Sign in to Google to save your progress. Learn more
Your Details (not the recipient)
Details of the person requesting a Parliamentary Celebratory Message.
First Name *
Surname *
Email Address *
Phone Number *
Street Address  (e.g. 5-9 Devlin St) *
Suburb *
Postcode (e.g. 2112) *
What is your relationship with the recipient? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Jordan Lane.

Does this form look suspicious? Report