Municipality Contact Information Update Form – Central Keystone Council of Governments

Municipality Information

Instructions Click "Submit" at the bottom of this form to send it directly to us. If you need additional lines for names, you can submit this completed form more than once.
Municipality Name *
Municipality Website:

Municipality Government (Board/Supervisors):

Name
Position/Title
E-Mail Address
Mailing Address
City, State, Zip
Contact Phone #
Name
Position/Title
E-Mail Address
Mailing Address
City, State, Zip
Contact Phone #
Name
Position/Title
E-Mail Address
Mailing Address
City, State Zip
Contact Phone #
Name
Position/Title
E-Mail Address
Mailing Address
City, State Zip
Contact Phone #

Municipality Appointee to CKCOG (Representative):

Name
Mailing Address
E-Mail Address
Title or Position
City, State, Zip
Contact Phone #

Municipality Secretary:

Name
E-Mail Address
Contact Phone #
Address
City, State Zip

Municipality Solicitor:

Name
E-Mail Address
Contact Phone #
Mailing Address
City, State ZIP

Other Contact Info: (Sewage Enforcement Officer, Zoning Officer, etc.)

Name & Title
Contact Phone #
E-Mail Address
Name & Title
Contact Phone #
E-Mail Address

Any other pertinent information:

Other Information

Verification

Please enter any two digits *Example: 12
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