Fire Rescue

Community Education Speaker Request

Group Name:

First Name:

Last Name:

Street Address:

City:

Zip/Postal Code:

Country:

Email Address: *This question is required. This question requires a valid email address.

Phone Number:

Ext:

Cell Number:

Presentation Requested:

Number of Participants This question requires a valid number format.

Age of Participants This question requires a valid number format.

Date and Time Preferred:

Driving Directions/Other Comments: *This question is required.

Note: Please provide a minimum of three weeks advance notice when scheduling a presentation so that we may accommodate your specific needs. This time frame will allow us adequate time to process your request and to notify all fire rescue participants. On occasion, there may be scheduling conflicts. We will make every attempt to accommodate each request on an individual basis.

Also, be aware that our fire and rescue vehicles are in service and subject to emergency calls during presentations and events. This may result in a delayed or possibly interrupted appearance. On occasion, they may be unable to appear.

If you would prefer to mail or fax this request to us, please print this page and refer to the contact information on website.

E-mail Disclaimer:

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.