Special Recognitions

Senator Durbin is proud to have the opportunity to recognize any Illinoisan celebrating a special occasion or outstanding achievement. In order for your request to be considered, please fill out the form below.

Your Name

Prefix*

First Name *

Last Name *

Your Contact Information

Street Address / P.O. box *

Street Address (2)

City *

County of Residence *

State *

Zip Code *

Home Phone*

Cell Phone

E-mail *

Verify E-mail *

Letter Details

Type of Greeting

Age

Event Date

Year

Event Date

Recipient Info

Shipping address is the same as requestor's address

Prefix*

First Name *

Last Name *

Street Address / P.O. box*

Street Address (2)

City *

State *

Zip Code *

Special instructions or information that will help to personalize the greeting*

I attest to the truthfulness of the information contained in this form. *

Senator Dick Durbin

Special Recognitions