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March Awareness Initiative

Proclamation Ambassador Form

Please register below listing your name, contact information, location of requested proclamation, and status. Please update the status of the request as appropriate.

    MSA Ambassador:

    State:

    E-mail Address:

    Proclamation Requested in:

    Proclamation Status:

    PDF or Photo of the Proclamation:

    Other Requests:

    Other requests you made:

    I agree to allow my name, city and state to be published on the MSA NJ website. Your e-mail address will remain confidential. Upon receipt of your proclamation, its photo and your name will be shared on MSA NJ and MSA Coalition Social Media.