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Las Cruces Fire Department Special Event Request Form

2. Special Event Request Form
4. Name of Organization*
6. Contact Name
   Please enter the name of the person from your organization who should be contacted with any changes to the event.
8. First Name*
9. Last Name*
11. Contact Person's Phone Number
12. Contact Person's Email address
14. Name or Type of Event*
    Please enter the title of your Event
16. Address of Event

18. Sessions for STATION TOURS have a maximum of 20 Individuals. If your Special Event will have more than 20 Children and Parents, more Sessions will be planned out on the same day.

20. Total Number of Individuals Attending Special Event*
    -- Select One --1-10 11-20 21-30more than 30
22. Number of Children*
23. Ages of Children

    1. 2-4 years old (pre K-Kinder)
    2. 5-11 years old(Elementary)
    3. 12 -17 years old (Middle and HS)
24. Number of Adults*
28. Requested Date and Time of Event
    Due to the continuing education and training that is required of the Fire Department Personnel, IF you are requesting a Fire Engine, Dates and Times are limited to Mondays, Thursdays, Saturdays and Sundays. We will do our best to work with your schedules. We will contact you with a confirmation of a workable Date and Time Request. Please enter three different options for your request.
30. Type of Service Requested *

    (Check all applicable boxes)

    1. Career Presentation
    2. Fire Exit/Evac Drills

    1. Fire Extinguisher Training
    2. Fire Safety and Prevention

    1. Station Tour
    2. EMS Stand By

    1. Hands Only CPR Training
32. First Option Date and Time of Event*
    First Option Date and Time of Event Start Date

    First Option Date and Time of Event Start Time

    —

    First Option Date and Time of Event End Date

    First Option Date and Time of Event End Time
33. Second Option Date and Time of Event
    Second Option Date and Time of Event Start Date

    Second Option Date and Time of Event Start Time

    —

    Second Option Date and Time of Event End Date

    Second Option Date and Time of Event End Time
34. Third Option Date and Time of Event
    Third Option Date and Time of Event Start Date

    Third Option Date and Time of Event Start Time

    —

    Third Option Date and Time of Event End Date

    Third Option Date and Time of Event End Time
36. Description of Presentation
40. If requesting a Station Tour, Please select which Station
    -- Select One --St 1 at 201 E. PicachoSt 2 at 1199 E. Foster Rd.St 3 at 390 N. Valley Dr.St 4 at 2802 E. Missouri Ave.St 5 at 5998 Bataan Memorial EastSt 6 at 2750 Northrise Dr.St 7 at 1050 Crawford Blvd.St 8 at 550 N. Sonoma Ranch Blvd.
42. Upload Brochures or Flyers
    Please upload any flyers or brochures or maps that are related to your request.
44. Special Needs/ Request
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field