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2. Name of Organization*
4. Address of Event (Pembroke Pines Only)*
6. Contact Person*
7. Email Address*
9. Business Phone Number*
10. Cell Phone Number
12. Type of Presentation*

    1. Outdoor (Fire Engines & Ladder Trucks)
    2. Classroom
    3. Bay Tour
    4. Other (see below)
13. Audience*

    1. Children
    2. Adult
    3. Senior Citizens
14. Age Range*
15. # of Participants*
17. If Other: Specify Presentation Type*
19. IMPORTANT INFORMATION:

    *Outdoor presentations begin at 9:00 AM 

    *Outdoor presentations are scheduled at the discretion of the Fire Department depending on weather conditions and availability. 

    *Standard presentation time is one (1) hour.

21. Select Date and Time (Weekday or Weekend)
23. First Selection*
    First Selection

    First Selection
24. First Selection confirmation*

    Is your first selection the only date available?

    1. Yes
    2. No
25. Second Selection*
    Second Selection

    Second Selection
26. Third Selection
    Third Selection

    Third Selection
28. Provide a Brief Description of Special Needs or Topics You Would LIke to Discuss*
30. Requested By:*
31. Today's Date*
    Today's Date
33. Approved By: (Fire Department Use Only)
35. 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.
37. A minimum of two weeks notice is required for scheduling purposes.
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field