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2. Details

   You can request staff from the Leander Fire Department to present informative presentations to your group on a variety of topics. 

3. 
5. Contact Name*

   Please enter your first and last name.

7. Organization Name*

   Please enter the name of the organization making a request.

9. Email*

   Enter the email address that you would like your confirmation sent to.

11. Street Address*

    Enter your residential street address. This will be verified to determine if you reside in our Fire District.

12. Phone Number*
14. Type of Event*

    What type of event will we be attending?

15. Education Topic*

    What do you want the topic of our lesson to be?

17. Event Location*

    Where is this event taking place?

19. Event Date
    Event Date

    On what day would you like for us to teach?

20. Start and End Times*

    What are the start and end times of our lesson? Example: Start at 10 am, End at 11 am.

22. Number of Adults (age 19 to 54)*
23. Number of Kids (age 0 to 18)*
24. Number of Senior Adults (age 55+)*
26. Target Audience*

    Who is the target audience? If a school or Daycare setting; what are the different grades levels/classes?

28. Presentation Materials Needed*

    1. None
    2. Laptop Computer
    3. Projector
    4. Projector Screen

    What presentation materials will we need to bring?

30. Other Information*

    Is there anything else we should know?

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