Community Outreach Group Presentation Request Form

2. 

4. Please call (972) 721-2651 to confirm your appointment after filling out this form.

6. Group Requesting

8. Date Requesting*
   Date Requesting

   Please indicate the date the event/presentation will take place.

9. Time Requesting*
   Time Requesting Start Time

   —

   Time Requesting End Time

   Please indicate time of event/presentation.

11. Address of Requested Location*

13. Contact Person*

15. Phone Number*

16. Email*

18. Requested Topic*
    -- Select One --Hands-Only CPRFire Apparatus ParticipationFire ExtinguisherFire Station VisitFire WardenHealth / Safety Fair

20. Group Size

    Minimum of 10

21. Age Group
    -- Select One --Children 0 to 11Youth 12 to 18Adults 18+Seniors 55+

23. Preferred Method of Contact*

    1. Email
    2. Phone

24. Preferred Language*

    1. English
    2. Spanish

26. Additional Information

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field