Duke and Duchess Recipient Verification Form

Being named a Duke or Duchess of Paducah by the Mayor’s office is an honor, and we are looking for ways to recognize the recipients. One of the first steps is to create the most accurate and verified database. Please take a few moments to complete this form.

Furthermore, Paducah Mayor George P. Bray and a team of volunteers are working to launch the Duke and Duchess of Paducah Foundation. Work is underway to draft mission and vision statements, bylaws, and more. This Foundation, once operational and substantially funded, will provide a path for community philanthropy.

Please note that as we work to verify this database, we may, in the future, request a photo submission of your Duke or Duchess award, if available.

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* 1. Tell Us Your Name

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* 2. Name on Duke or Duchess if different from above.

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* 3. What is your mailing address?

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* 4. At what email address would you like to be contacted?

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* 5. Please provide a contact phone number.

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* 6. What is your date of birth?

Birthday

Date

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* 7. Which award did you receive?

Duke

Duchess

I did not receive an award.

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* 8. If you are a friend/family member of the person who received this form, please let us know their status.

I am the award recipient.

The award recipient has moved, and I don't have the forwarding address.

The award recipient has passed away.

Other (please specify)

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* 9. What year did you receive the Duke or Duchess award? if you don't know or did not receive an award, skip this question.

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* 10. Were you living in Paducah at the time you received the award?

Yes

I did not receive an award.

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* 11. If you know the name of the person who nominated you, please enter it. (Skip if you did not receive an award.)

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* 12. Briefly explain why you received a Duke or Duchess. (Skip if you did not receive an award.)

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* 13. I would like to be involved in the Duke and Duchess of Paducah Foundation in the following ways (check all that apply).

I would like to serve on the Foundation’s future board of directors.

I would like to know more about ways to volunteer through the Foundation.

I would like to know more about opportunities to donate to the Foundation.

I would like to receive updates about the Foundation’s development and progress.

I would like to provide my services or facilities to assist in the Foundation's development (explain in the Other box below).

Other (please specify)

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* 14. I want to be included on an email list to receive updates about ways to recognize Duke and Duchess recipients and about the Duke and Duchess of Paducah Foundation.

Yes

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* 15. I confirm that the details provided above currently are accurate to the best of my knowledge, and I consent to the use of this information for record-keeping.

Yes

Information provided will be used solely by the City of Paducah and the Duke and Duchess of Paducah Foundation and will not be provided and/or sold to any third party.