2013 Clean Sweep Patch & Certificate Request
Complete this form AFTER your cleanup. IMPORTANT: Be sure you have the correct spelling for all individuals you will be listing before you get started. If you or your group participated in Shelton Clean Sweep, you are eligible for our 2013 iron-on patches and a certificate from Mayor Lauretti, to be awarded at our recognition event on June 12 at 7:00 pm. We will have refreshments, door prizes, and call up each person to receive their certificate and patch from the Mayor. This event is especially popular with Scouting groups. We can send out individual invitations to each member of your group if you supply us with their addresses. Unclaimed certificates can be picked up at City Hall after the event, or we can mail them out.
Group Name** *
**Exactly as it should appear on the certificates, e.g. "Girl Scout Troop 363." If you are reporting as an individual, enter your own name.
Contact Name
Contact email
Contact phone
Contact address
Would you like to receive an invitation to our Clean Sweep Recognition Event (to be held in June)? *
We will have refreshments, door prizes, and each person will be called up to receive their certificate & patch from the Mayor. Especially popular with Scouting groups. To receive individual invitations, you must enter an address for each volunteer later in this form. Otherwise the invitation will be sent to the group contact.
Please list the names and addresses of each person who should receive a certificate. If you would prefer patches without certificates, indicate that in the space below, and specify how many patches you would like.
Check your spelling please! One line per person. Address is optional - to be used for invitations if those have been requested. You can also opt for one certificate with the group name (indicate below).
Did your group have any 'tag-a-longs' or others that should have a different or no Group Name on their certificate? Please indicate how the certificates should read for these individuals below.
Example: A brother or father of a Girl Scout might not want his certificate to say "Girl Scout" on it. Or you may have had a few participants from other troops.
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