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2. 
4. First Name
5. Last Name
7. Address
9. Phone Number
10. Email
12. Organization Requesting Use, If Applicable
14. Description of what the Town Seal is going to be used for
16. Is this associated with an event

    1. Yes
    2. No
17. If yes, please describe the event including the date and location
19. Type of media the Town Seal will be used for

    1. Print (brochure, postcard, flyer)
    2. Online (social media, website)
    3. Presentation (PowerPoint, Adobe)
    4. Other
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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