Emergency Preparedness Presentation Request
Please provide information below so we can present pertinent information to your group.
Organization Type *
What type of organization do you represent?
Organization Name *
Name
Your answer
Household demographic
Is your organization made up of families, singles or mixed?
Age demographic
What age group is your organization's audience?
Your answer
Special Needs
Do you require any special needs information?
Your answer
Languages
Any non-English needs? (state language(s) or 'no')
Your answer
Pets
Will pet safety and preparedness be a concern?
Regular presentations
If you would like regular presentations, how often?
Time Available *
How much time would you like for the presentation to take?
Your answer
Desired Dates and Time *
List three dates, no sooner than 30 days from now, in order of preference.
Your answer
Contact *
Who is the point of contact for your organization? Name, Email, Phone Number
Your answer
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