Request an Emergency Preparedness or Hazard Focused Presentation

2. If you would like a public educator from Pierce County Department of Emergency Management to speak about the hazards we have in Pierce County, how to create an emergency plan, and how to build an emergency kit, please fill out the form below.

   If you would like a public educator from Pierce County Department of Emergency Management to speak about the hazards we have in Pierce County, how to create an emergency plan, and how to build an emergency kit, please fill out the form below.

4. Name of Agency or Community Group

6. Address of Presentation

8. City

9. State

10. Zip

12. Preferred Date, Time and Duration of Presentation
    Please allow 1-2 weeks for a public educator to contact you regarding your presentation request. A confirmation or a request for additional dates/times will be sent via email. The duration of an emergency preparedness presentation can range anywhere from 20 minutes to one hour. Please keep this in mind when you provide a presentation time. The time frame you list does not include set-up or take-down. The presenter will set-up 10-15 minutes before the start of the presentation and take-down shortly after the presentation concludes.

    Please allow 1-2 weeks for a public educator to contact you regarding your presentation request. A confirmation or a request for additional dates/times will be sent via email. The duration of an emergency preparedness presentation can range anywhere from 20 minutes to one hour. Please keep this in mind when you provide a presentation time. The time frame you list does not include set-up or take-down. The presenter will set-up 10-15 minutes before the start of the presentation and take-down shortly after the presentation concludes.

14. First Choice - Date/Time
    First Choice - Date/Time

    First Choice - Date/Time

15. Second Choice - Date/Time
    Second Choice - Date/Time

    Second Choice - Date/Time

16. Preferred Duration of Presentation

18. Point of Contact
    Before the presentation

    Before the presentation

20. First Name

21. Last Name

23. Email

24. Phone Number

26. Point of Contact
    Day of the presentation

    Day of the presentation

28. 1. Check if same as above.

30. First Name

31. Last Name

33. Email

34. Phone Number

36. Audience

38. Audience Demographics

    Please list audience demographics (i.e. age, special needs, etc.).

39. Expected Number of People

    Does not need to be exact, estimating a number range will ensure that the public educators bring enough handouts for each audience member.

41. Technology
    If you are unable to provide any of the items listed below, we can provide them for you.

    If you are unable to provide any of the items listed below, we can provide them for you.

43. Is there a computer or laptop available?
    -- Select One --YesNoNot Sure

44. Is there a projector available?
    -- Select One --YesNoNot Sure

45. Is there a screen or white wall to project on?
    -- Select One --YesNoNot sure

Leave This Blank:


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

    This field is not part of the form submission.

49. Submit Submit and Print

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