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Everyone Belongs Pledge

  1. I believe that Everyone Belongs in Pleasant Hill. 

  2. I pledge to (check all of the boxes below):*
  3. I would like my certificate and decal sent to me in the following format (select one):*
  4. Fill out this section only if requesting a mailed certificate/decal:

  5. I would like my name and/or business name to be added to the public website to show that I have taken the pledge (check yes or no below).*
  6. Leave This Blank:

  7. This field is not part of the form submission.