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