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Emergency Preparedness Presentation Request
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Steps
1.
Step One
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2.
Contact Information
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Step One
Please provide the following information so we can present pertinent information to your group.
Organization Name
*
Organization Type
*
-- Select One --
HOA
School
Apartment Complex
Church
Civic Group
Business
Other
What type of organization do you represent?
Household Demographic
-- Select One --
Families
Singles
Mixed
Is your organization made up of families, singles or mixed?
Age Demographic
What age group is your organization's audience?
Special Needs
Do you require any special needs information?
Languages
Any non-English needs? Please state language(s) or 'no'.
Pets
Yes
No
Will pet safety and preparedness be a concern?
Regular Presentations
No
Yes - Bi-annual
Yes - Annual
If you would like regular presentations, how often?
Length of Presentation
*
How much time would you like for the presentation to take?
Desired Dates and Time
*
List three dates, no sooner than 30 days from now, in order of preference.
Continue
Contact Information
Who is the point of contact for your organization?
Name
*
Email Address
*
Phone Number
*
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