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2. Facility Use / Training Resource Request Form

   Please provide as much information as possible.

4. Requesting Agency / Organization
6. Organization Address*
8. Address2
10. City*
11. State*
12. Zip*
14. Point of Contact Name
16. POC Email Address
17. POC Phone
19. Dates of Requested Use
    Dates of Requested Use Start Date

    Dates of Requested Use Start Time

    —

    Dates of Requested Use End Date

    Dates of Requested Use End Time

    Please enter the date(s) and time(s) you're requesting use of the facility or equipment.

21. Resource(s) Requested:
23. Classroom(s)

    Please identify how many people you need to accommodate.

    1. 1-20 attendees
    2. 20-40 attendees
    3. 40-60 attendees
    4. 60-80 attendees
    5. 80+ attendees
24. Facility Space

    1. Training Bay
    2. Smoke Maze
    3. Burn Building
    4. Drill Tower
    5. Confined Space Sim
    6. Trench Rescue Sim
    7. Pavilion
    8. Vehicle Rescue Pad
    9. EVOC Space
    10. Drafting Pond
25. Training Props

    1. Flammable Liquid Pit
    2. Fire Ext. Prop (Fire)
    3. Fire Ext. Prop (Laser)
    4. Roof Prop (Large)
    5. Roof Prop (Small)
    6. Christmas Tree Fire Sim
    7. Propane Tank Fire Sim
    8. Split Flange Fire Sim
    9. Dumpster Fire Sim
    10. Car Fire Sim
    11. Forcible Entry Door
    12. Mannequins (please note how many below)
26. Apparatus and Trailers

    1. Engine 99-1
    2. Engine 99-2
    3. Engine 99-3
    4. HAZMAT Ops Trailer
    5. HAZMAT Tech Trailer
    6. Forcible Entry Trailer
    7. Air Cascade Trailer
    8. Tech Rescue Trailer
28. Additional Notes
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field