Please complete the below form to book a Rural Fire Service Community Education presentation/attendance. Booking Request Contact details Contact name Address line 1 Address line 2 Suburb Post code Email address Email address Confirm email Preferred contact method Email Phone Postal Approximate age of group 3-5 5-11 11-18 18-35 35-55 55+ Expected participants Number Presentation details Presentation requested Presentation requested - Select -PREPARE.ACT.SURVIVEProperty adviceFire EdSmoke alarm educationFire warden & permit to light systemOther… Enter other… Location of presentation Address line 1 Address line 2 Suburb Post Code Preferred date and time Preferred date and time: Day Day12345678910111213141516171819202122232425262728293031 Preferred date and time: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Preferred date and time: Year Year202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Preferred date and time: AM/PM AM/PMampm Alternate date and time Alternate date and time: Day Day12345678910111213141516171819202122232425262728293031 Alternate date and time: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Alternate date and time: Year Year202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Alternate date and time: AM/PM AM/PMampm Additional/special requirements Do you have any of the following equipment available that our presenter can use? Whiteboard Screen Table Other… Enter other… Other comments CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit presentation request #f6a800
