Form Center

2. Name of Group/Organization*
3. Contact Person*
   First and Last Name
5. Primary Phone*
6. Secondary Phone
7. Email*
9. Type of Event Requested*

   1. School/Children's Presentation
   2. Police Station Tour
   3. Crime Prevention Presentation
11. Crime Prevention Topic of Interest
    -- Select One --ALICE Active Shooter TrainingBusiness Block Watch IntroductionBicycle SafetyChild SafetyCrime Prevention Through Environmental Design (CPTED) SurveyDomestic Violence/StalkingEviction/Landlord Tenant ConcernsGangs/GraffitiIdentity Theft/Financial CrimesInternet SafetyNeighborhood Watch IntroductionPersonal SafetyTheft PreventionOther (describe below)
13. Other (please describe)
15. Day of Week
    -- Select One --MondayTuesdayWednesdayThursdayFriday
16. Date Preference
    Date Preference Start Date

    —

    Date Preference End Date
17. Time Preference
    Time Preference
18. Time Limit
    -- Select One --15 Minutes30 Minutes45 Minutes1 Hour1 Hour 15 Minutes1 Hour 30 Minutes
20. Event Location
    Complete Address
22. Attendee Information
24. Number of Attendees
25. Age Range
26. Special Accommodations Requested
28. Additional Information
30. If we receive a public records request, do you want your identity protected?*

    1. Yes
    2. No
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field