Prince George's County Department of Parks and Recreation
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Centenarian Form

Do you know any Prince George’s County residents who are 90 years old or better?

The Prince George’s County Department of Parks and Recreation is collecting information about county residents who are ages 90 & older.  Special recognition will be given to centenarians - residents who are 100 years old & older - at a spring event. We need your help identifying Prince George’s County residents ages 90 & above. If you know someone who resides in the county and will be 90 years old or better as of January 1, 2014, please share the information with us. Your help is greatly appreciated! Please forward the information below to us no later than February 28, 2014 by:

(a) Calling staff at 301-446-3400 (TTY 301-446-3402) and providing the information below, or

(b) Answering the questions below online and clicking the button that says “submit.” 

Page 1 of 1
1. Name of Prince George’s County resident age 90 or over
2. His/her age and birth date (including year) - mm/dd/yyyy : (e.g. age 95, date of birth 12/04/1918)
Current age:
Age as of May 1, 2014:
Date of Birth:
3. His/her address:
4. YOUR name (if different than 1. above):
5. YOUR phone number:
 
6. YOUR Email address:
 
7. If you're completing this form about someone other than yourself, please tell the person named in Question 1 that an invitation to the Centenarian Event will be mailed to him/her sometime in April, 2014. To what address should that invitation be sent?
Send the invitation to the address listed above for Question 3; OR
Send the invitation to the following address:
Address to send invitation: