EVENT REQUEST FORM

Presentation / Event Request Form

Organization / Event Sponsor(*)
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Organization / Event Sponsor

Date & Time (Tentative)(*)

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Date & Time are tentative until they are confirmed.

Address(*)
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Address of presentation.

City(*)
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City of presentation.

State(*)
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State of presentation.

Zip Code(*)
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Zip code of presentation.

Presentation Requesting(*)
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Please select what presentation you would like.

If OTHER or Safety Presentation Chosen, Please Describe:
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Please describe the type of presentation.

Event Desription
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Please describe event.

Type of Audience
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Type of Audience

Estimated Numbers of Attendees
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Estimated Numbers of Attendees

Are there Dignitaries Attending?
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Are there Dignitaries Attending?

If Yes or Invited, Please List.
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If Yes or Invited, Please List.

EVENT CONTACT INFORMATION
Name(*)
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Name

Contact Number(*)
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Contact Number

Cell Phone (If Applicable)
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Cell Phone (If Applicable)

Email Address(*)
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Email Address

LOCAL NOTIFICATION
Have You Notified Your Local Police Department About the Event?(*)
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Have you notified your local police department about the event?

If yes, Please Provide Contact Name and Number.
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If Yes, please provide contact name and number.

reCAPTCHA
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I Am Not A Robot : )

Sheriff's Office

building10 Main Street
       Hackensack, NJ 07601

phonePhone: (201) 336-3500

faxFax: (201) 487-5137

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Bergen County Sheriff's Office 

building10 Main Street • Hackensack, New Jersey 07601

phonePhone: (201) 336-3500

faxFax: (201) 487-5137

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