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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 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
Primary Contact *This question is required.
Add Another Contact
Secondary Contact
This question requires a valid date format of MM/DD/YYYY.
Preferred Time
Audio Visual Equipment with sound available on site? *This question is required.