Certificate Request Form | Official Website - Assemblymember Isaac G. Bryan Representing the 55th California Assembly District

Certificate of Recognition can be requested to honor individuals or organizations for any of the following reasons:

Significant contributions to the local community or the State of California
Special achievements by residents, businesses, or organizations of the 55th Assembly District
In Memoriam certificates upon the passing of an upstanding community member
To mark organizational milestones (e.g. business/organization anniversary, the opening or expansion of a facility, etc.)

Certificate requests are approved at the discretion of Assemblymember Bryan and his staff.

Minimum Processing Times for Certificates

Event Information

Event Description

Event flyer (if available)

One file only.
200 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf, doc, docx.

Event Link (if available)

Event Date & Time

Name

Phone

	Will you be submitting a request for Assemblymember Bryan or a member of his staff to attend this event?
Yes	Yes
No	No

If yes, please also complete an Event Request.

Honoree Information

*Enter the following information exactly as you wish it to appear on the certificate.

Name (Individual or Organization)

Title/Position

	Is the Honoree a resident of or headquartered in the 55th Assembly District?
Yes	Yes
No	No

Find your Assembly district.

Preferred Pronouns

Reason for Recognition

If requesting a certificate In Memoriam, please include date of birth and date of passing.