Request a Congratulatory Message

Your Name*
First Last
Your Email*
Your Phone*
Your Address
Street Address City/Suburb/Town State Postcode
Name of Person(s) celebrating anniversary/birthday (including title)*
Occasion (please choose)*
- 50th Wedding Anniversary
- 60th Wedding Anniversary
- 90th Birthday
- 100th Birthday
Date of anniversary/birthday*
DD slash MM slash YYYY
Person(s) home address*
Address where messages are to be sent*
Date which messages are to arrive*
DD slash MM slash YYYY
Supporting documentation (choose one)*
- Will post statutory declaration to 172 High Street, Wodonga VIC 3690
- Will hand deliver statutory declaration or original documentation to 172 High Street, Wodonga VIC 3690
Message (if required)
Please advise the office immediately if circumstances arise which make it inappropriate for the message to be sent.
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