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2. Name of Organization*
4. Business Address*
6. Contact Person*
7. Email Address
9. Phone Number*
10. Fax Number*
12. Type of Presentation*

    1. Outdoor (Fire Engines & Ladder Trucks)
    2. Classroom
    3. Auditorium
    4. Station Tour
13. Audience*

    1. Children
    2. Adult
    3. Senior Citizens
14. Age Range*
15. # of Participants*
17. NOTE: Classroom and Outdoor Presentations cannot be scheduled on the same day.
19. Select Date and Time (Weekday or Weekend)
21. First Selection
    First Selection

    First Selection
22. Second Selection
    Second Selection

    Second Selection
23. Third Selection
    Third Selection

    Third Selection
25. Provide a Brief Description of Special Needs or Topics You Would LIke to Discuss
27. Requested By:*
28. Today's Date*
    Today's Date
30. Approved By: (Fire Department Use Only)
32. NOTE: This request is contingent upon availability of staffing and equipment. Every effort will be taken not to disappoint you. However, emergency calls and unforeseen conflicts are our first priority.
34. A minimum of two weeks notice is required for scheduling purposes.
36. YOU MAY PRINT AND FAX THIS FORM OR SUBMIT ELECTRONICALLY. FAX NUMBER (954) 517-8430
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field