Birthday Citation Request

My office accepts citation requests at all times, but please allow three to four weeks prior to an event for a request to be processed. If a citation is needed in two weeks or less, please give my office a call to ensure appropriate arrangements are made. While we do try our best, we cannot guarantee a citation will be available by a certain date. For any questions, please contact my office at 717-749-7384.

General Information

Full Name of Person to be Cited *

Address Line 1 *

Address Line 2

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City *

State *

Zip Code *

Phone Number (with Area Code) *

Would like Rep. Schemel to present this citation *

In Person
In Private

Preferred Date *

Preferred Time *

Preferred Location *

Notes

Birthday Informaiton

Individual's Full Name *

Title (i.e. Mr., Mrs., Miss, Ms.) *

Date of Birth *

Location of Birth

Number of Children

Names of Children

Number of Grandchildren

Names of Grandchildren

Number of Great-Grandchildren

Names of Great-Grandchildren

Community Service or Other Notable Achievements

Contact Information

Name of Applicant *

Applicant's Phone Number *

Applicant's Email Address *

Leaving this box checked verifies that you would like to receive legislative email updates.

Applicant's Street Address *

Applicant's City *

Applicant's State *

Applicant's Zip Code *

Additional Notes

Please forward any other appropriate information to jpeters@pahousegop.com.