Citizens Awards Recognition Campaign

Please note: The fields marked * are mandatory.
Enter full mailing address including postal code
If team, please provide first and last name of team roster:
Social Accounts
Where applicable, the City of Brampton may tag your professional or affiliated social accounts. Please provide the handles for your professional or organizational accounts.

By checking the box above on behalf of yourself (or as the legal guardian of a recipient under 18 years of age) I am agreeing to the terms and conditions listed in regards to the use of your (or your child(s) image). Media Release ​Form​
Only jpg, jpeg, png, pdf file types are allowed.
Only jpg, jpeg, png, pdf file types are allowed.
Only jpg, jpeg, png, pdf file types are allowed.
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Privacy Statement

The personal information on this form is collected under authority of the Municipal Act, SO 2001, c. 25. The information will be used to process the Citizen Award Nominations. Questions about the collection of personal information should be directed to City Clerk's Office, 2 Wellington Street West, Brampton, Ontario L6Y 4R2 905.874.2100 or accessibility@brampton.ca. Please review the City’s Privacy Statement for more information.

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