2025 Lifelong Learning & Service Recognition (LLSR) Convocation Reply Form

Please complete this form by Friday, May 9, 2025. Email education@agd.org if you have any questions.

Convocation attendance is optional for LLSR Recipients, however we need a completed form for our records.

AGD Member ID

First Name

Constituent Name

Middle Initial

Last Name

Select preferred option

I WILL attend Convocation Ceremony July 12, 2025 in Montréal, QC

I WILL NOT attend Convocation Ceremony July 12, 2025 in Montréal, QC (*if you are not attending, please make sure you fill out the next two items)

Please confirm how you would like your name to appear on your LLSR Crystal.

Please confirm your mailing address to receive your LLSR Crystal. Please note LLSR Crystals will not be delivered to P.O. Box addresses

Name

Address

City

State/Providence

Zip Code

If you and your spouse or other family member are receiving the 2025 LLSR Recognition, please provide their name here so we can seat you together

If you and your spouse or other family member are receiving a different award or recognition, please provide their name here

Family members receiving different awards/recognitions cannot be seated together, but AGD staff will provide direction so you can have your photos taken together on-stage with the AGD president.

Sponsored by AGD Corporate Sponsors:

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