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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.
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.
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
20. First Name
21. Last Name
23. Email
24. Phone Number
26. Point of Contact
    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.
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

* indicates a required field