Form Center

2. FIRE DEPARTMENT PUBLIC RELATIONS/PUBLIC EDUCATION REQUEST FORM
   Due to the high volume of appearance request we receive, a minimum of 2 weeks prior to the requested event date is required. Additionally, please note there will be times that we many not be able to make your function or have to leave due to an emergency . Please note: (*) indicates required fields
4. Event Information
6. Event Date and Start Time (must be two weeks in advance):*
   Event Date and Start Time (must be two weeks in advance): Start Date

   Event Date and Start Time (must be two weeks in advance): Start Time

   —

   Event Date and Start Time (must be two weeks in advance): End Date

   Event Date and Start Time (must be two weeks in advance): End Time
8. Group/Affiliation:
10. Age Group of Participants:*
11. Number of Children Attending*
12. Number of Adults Attending*
14. Address of Event:*
16. City*
17. State*
18. Zip*
20. Type of Public Relations Event:*

    1. Station Tour
    2. Public Appearance
    3. Fire Extinguisher Training (See Next Section)
22. Fire Extinguisher Training - Will you provide Fire Extinguishers for your training event?

    1. Yes
    2. No
24. If a Station Tour Select Fire Station Requested

    1. Fire Station 1- 1200 Rudel Rd.
    2. Fire Station 2- 11725 Holderrieth Rd.
    3. Fire Station 5- 19900 Telge Rd.
26. Group Contact Information:
28. First Name*
29. Last Name*
31. Email address:*
32. Phone Number*
34. Additional Event Information:
Leave This Blank:


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

    This field is not part of the form submission.

38. Submit

* indicates a required field