Rutland Will Have Fireworks!
Know the song?  Sing along to Katy Perry as you fill this out :D
Sign in to Google to save your progress. Learn more
Email *
This was us in 2019.  We can get there again in 2022 - but only with your help. Sponsor a Rutland Firework for 2022 and get your name in the official Rutland Tricentennial 4th of July list of fireworks supporters!  (photo credit/copyright 2021 by Kill the Ball Media)
First Name (s) *
Last/Family Name (s) *
This firework is being sponsored in the name of:  ( if you would like to remain anonymous please note here!) We will write what you write, for example:  "In honor of Scotty Smalls, who loved 4th of July fireworks", or "sponsored by Atlas Fireworks" , or "The Davis Family". *
This sponsorship is in honor of *
Street Address *
State *
Zip Code *
Firework type you'd like to sponsor.   Don't know your big fireworks?  Here's a primer:  https://www.pbs.org/a-capitol-fourth/fireworks-fun/firework-names/ *
Your donation amount, which must be either mailed to Rutland 4th of July Committee, Community Hall, 250 Main Street, Rutland MA 01543;  or online via the town's UniPay (takes electronic checks or credit cards): https://www.townofrutland.org/home/pages/pay-bills-online      On 4th of July weekend 2021, all received donations $25 and up received a FREE RUTLAND TRICENTENNIAL sticker;  moving forward, all donations $30 and up receive a sticker!   We thank you for your support! *
Captionless Image
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy