Drowning Prevention Coalition

Presentation Request

Request a Water Safety Presentation

Instructions: Please note that due to staff limitations, only groups with TEN (10) OR MORE participants can be scheduled for a seminar. If your group includes less than ten (10) participants, you may wish to partner with additional organizations to achieve the minimum participant requirement.

Once the form is fully completed, press SEND to submit.

Completed forms may also be emailed to astewart@pbcgov.org OR faxed to 561.616.7084

Incomplete forms will not be reviewed, please make sure all information is provided. Please allow at least two weeks lead time when completing your requested presentation dates.

About Your Organization

Organization Name *This question is required.

Street Address *This question is required.

Steet Address Line 2

City *This question is required.

State

Postal / Zip Code

Primary Contact *This question is required.

First Name

Last Name

Phone Number

Email Address

Add Another Contact

Secondary Contact

First Name

Last Name

Phone Number

Email Address

Age Group or Range *This question is required.

How Many People Will Attend?

Preferred Date This question requires a valid date format of MM/DD/YYYY.

calendar

Preferred Time

From
Until

Audio Visual Equipment with sound available on site? *This question is required.

Other Information