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2. First Name*
3. Last Name*
5. Business or Group Name (If Applicable)
7. Address1
9. City
10. State
11. Zip
13. Your email address*
14. Your phone number*
16. Reply email address
18. Event Description*

    Please describe the type of event that you would like us to attend.

19. Event Starting Date/Time*
    Event Starting Date/Time

    Event Starting Date/Time

    Enter the starting date and time of your event

20. Event Ending Date/Time*
    Event Ending Date/Time

    Event Ending Date/Time

    Enter the ending date and time of your event

22. Equipment Requested?

    Select the type(s) of equipment you are requesting.

    1. Engine
    2. Ambulance
    3. Ladder Truck
    4. Survive Alive Trailer
23. Radio Buttons

    1. Button 1
    2. Button 2
    3. Button 3
    4. Button 4

    Radio Button Test

25. Class Request
    -- Select One --Station TourCPR ClassFirst Aid ClassFirst Aid & CPR ClassSenior Safety ClassFire Extinguisher Class

    Select the class you're requesting

26. Number of People in Class
28. Please add other details
30. Attach file as needed
32. 

33. Please call us at 262-532-8803 with any questions.

    Thanks!

34. Visit our Webpage!
    Fire Department Website
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

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