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Community Outreach Group Presentation Request Form
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This form has been modified since it was saved. Please review all fields before submitting.
Please call (972) 721-2651 to confirm your appointment after filling out this form.
Group Requesting
Date Requesting
*
Date Requesting
Please indicate the date the event/presentation will take place.
Time Requesting
*
Time Requesting Start Time
—
Time Requesting End Time
Please indicate time of event/presentation.
Address of Requested Location
*
Contact Person
*
Phone Number
*
Email
*
Requested Topic
*
-- Select One --
Hands-Only CPR
Fire Apparatus Participation
Fire Extinguisher
Fire Station Visit
Fire Warden
Health / Safety Fair
Group Size
Minimum of 10
Age Group
-- Select One --
Children 0 to 11
Youth 12 to 18
Adults 18+
Seniors 55+
Preferred Method of Contact
*
Email
Phone
Preferred Language
*
English
Spanish
Additional Information
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