2. Request for Talk or Demonstration
4. Date Request Received*
   Please fill out today's date.
6. Requested Submitted by:*
   Your Name
8. Person/Group making request:*
9. Address of Person Making Request*
11. Phone Number of Person Making Request*
12. Date of Birth of Person Making Request*
14. Date of Event*
15. Time of Event*
17. Type of Event*
    What type of event are you having. Church group talk, scout tour etc.
19. Address of Event*
    If Tour, put Police Department
20. Anticipated Size of Group*
22. Subject Requests/ Special Requests
    Please explain in detail what your event is, the purse, and what subjects you would like officers to discuss.
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field