Phone:
03 9350 5777
Fax:
03 9350 6613
Email:
Kelvin.Thomson.MP@aph.gov.au
Congratulatory Messages
(
*
required information)
*
First Name:
*
Last Name:
*
Street Address:
*
Suburb:
*
Postcode
Home Phone:
Mobile Phone:
Business/office Phone:
Fax Number:
*
Email Address:
*
Recipient's Name: (as it appears in the message)
*
Street Address the Message Should be Sent to:
*
Recipient's Suburb:
*
Recipient's Postcode:
*
Anniversary Type
Do you have supporting evidence?
50th Wedding Aniversary or Higher
60th wedding Aniversary or Higher
90th Birthday or Higher
100th Birthday or Higher
Birth Certificate (for Birthdays)
Marriage Certificate (for Wedding Anniversaries)
Statutory Declaration
*
Date of Birthday or Anniversary:
If you have any difficulties with this form, or would prefer to talk to someone about your request, please call the office on (03) 9350 5777
For Protection from SPAM we ask you to please enter the Letters and Numbers in the Graphic in the box provided.
