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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.

   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. Number of Children*

19. Ages of Children*
    -- Select One --3-5 years old (Pre-K)6-11 years old (Elementary)12-14 years old (Middle School)15-18 years old (High School)All Ages

20. Number of Adults*

24. 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.

    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.

26. Type of Service Requested *

    (Check all applicable boxes)

    1. Career Presentation
    2. Fire Engine Visit

    1. Fire Exit/Evac Drills
    2. Fire Extinguisher Training

    1. Fire Safety and Prevention
    2. Station Tour #

    1. EMS Stand By
    2. Other
28. 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

29. 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

30. 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

32. Description of Presentation

36. If requesting a Station Tour, Please select which Station
    -- Select One --12345678

38. Upload Brochures or Flyers

    Please upload any flyers or brochures or maps that are related to your request.

40. Special Needs/ Request

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field