Birthday and Anniversary Greetings Form

The Mayor gladly provides greetings to Port Coquitlam residents celebrating birthdays of 75 years and up, as well as to Port Coquitlam couples celebrating anniversaries, starting at the 40th. Greetings are issued in five year increments, e.g 75, 80, 85 or 40, 45, 50.

You can provide this information by completing and submitting the request form below or by writing or faxing:

Mayor’s Office
Port Coquitlam City Hall
2580 Shaughnessy Street
Port Coquitlam, BC V3C 2A8
Fax 604.927.5331

Birthday and Anniversary Greetings

Name of Celebrant(s) (as it should appear on certificate) *

Phone

Address

City

Province

Postal

Occasion *

Years (Birthdays 75+; Anniversaries 25+) *

Date of Birthday or Anniversary (e.g. January 1, 2005) *

Date of Celebration (if different than above)

Mail greetings to (if different than celebrant(s))

Contact Name (if different than celebrant(s))

Telephone

Special Requests / Comments

Personal information collected on this form by the City of Port Coquitlam will only be used for the purposes for which it was collected under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act (FOIPPA). If you have any questions regarding the collection of this information, please contact the City’s Records and FOIPPA Administrator at 604-927-5250 or clerks@portcoquitlam.ca.

Date

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