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2. Requester Information

4. Full Name / Organization (as it will appear on certificate)
6. Address
8. City
9. State
10. Zip Code
12. Phone Number
13. Fax Number
15. Email Address

17. Flag Request Details

19. Desired Fly Date
    Desired Fly Date
20. Rain Date
    Rain Date
22. Occasion / Dedication

    (Optional, max 50 words)

24. Number of Days Requested

    1 day (default); Additional days (fee applies)

26. Acknowledgements

    By submitting this request, I acknowledge:

    1. The flag will be physically flown on the designated Rowan County Government Building flagpole in accordance with the US Flag Code.
    2. The flag will be flown on the date specified above unless weather or official ceremonies require rescheduling.
    3. The request must be submitted at least two weeks in advance.
28. Signature of Requester
29. Date
    Date
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field