Public Outreach Opportunities

2. First Name*
3. Last Name*
5. Phone Number*
6. Email*
8. Location of the Event:
9. Business Name (if applicable)
10. Address*
12. City*
13. State*
14. Zip Code*
16. Event Information:
17. Date of the Event*
    Date of the Event

    Please give at least one month notice.

18. Time of the Event*
    Time of the Event
19. How long is the event?*
    -- Select One --Half an HourOne HourTwo Hours
21. Estimated Number of Attendees*
22. Age Range of Attendees*
23. Which instructional topic are you requesting?*
    -- Select One --Business fire drillFire engine display at community eventFire engine visit with safety presentationFire extinguisher presentationFire safety presentationSparky visit
25. Additional Comments
27. I understand that the La Vergne Fire Rescue Department, its resources, and employees, cannot be used to support events intended to generate revenue for companies. This includes events such as grand openings or customer appreciation days designed to attract people toward a business. This does not include strictly educational events such as a presentation at a daycare or a safety talk for an employee group.*

    1. I agree.
29. I understand that the La Vergne Fire Rescue Department, its resources, and employees, cannot attend any event that would create the impression of suport or endorsement for any political candidate.*

    1. I agree.
Leave This Blank:


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

    This field is not part of the form submission.

33. Submit

* indicates a required field