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2. Please complete the following information.
4. Organization Name
5. Primary Contact
7. Organization Address
9. City
10. State
11. Zip
13. Contact Phone Number
14. Contact Email Address
16. SFD Participation Requested

    Select all that apply

    1. Drive-By Birthday
    2. Fire Drill & Evacuation Observation
    3. Fire Extinguisher Training
    4. Fire Prevention Education
    5. Fire StationTour
    6. Fire Truck Visit
    7. Non-Certified Hands Only CPR Training
17. Organization Type

    1. Charity (i.e. Red Cross, Salvation Army, CPO)
    2. Community Group (i.e. Neighborhood Association)
    3. Government
    4. Healthcare
    5. Private Education
    6. Public Education
    7. Religious Organization
    8. Residential Facility
    9. Service Organization (i.e. Boy Scouts, Lions Club)
    10. Other
19. Fire StationTour

    Please specify which fire station you would to tour. 

20. Organization Type - Other

    Please provide a brief description of your organization. 

22. Community Event Date & Time
23. Community Event Anticipated Attendance
25. Participant Age Groups

    Select all that apply

    1. Preschool
    2. Elementary School

    1. Middle School
    2. High School

    1. College
    2. Adults

    1. Seniors
    2. Families
27. Fire Prevention Education Scheduling

    Please indicate which days and times work best.  Select all that apply. 

    1. Monday
    2. Tuesday
    3. Wednesday

    1. Thursday
    2. Friday
    3. Saturday

    1. Morning
    2. Afternoon
    3. Evening
29. Request Details

    Please provide a brief summary of your request.  

31. Available Education Aids

    Please indicate which equipment available at the location for use during education. 

    1. Computer
    2. Projector (with audio)
    3. Projector (no audio)
    4. Screen/Monitor
    5. White Board
33. Attachments

    Please attach PDF copies of any documents related to your request such as event flyer, event schedule, parade route maps, etc.  

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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

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