Brevard County Fire Rescue Speaker Request Form

Please read this first before you start.

Please provide at least one (1) month advance notice when scheduling your event so that we may accommodate your specific needs. This time frame will allow us adequate time to process your request and to notify all fire rescue participants. We will make every attempt to accommodate each request on an individual basis. Please complete this form and then click on the Submit Form button at the bottom of the page. A representative will contact the requestor within two (2) business days. If you have any questions or concerns, please contact Fire Prevention at 321-637-5660.

All required fields are indicated with an * asterisk.

Contact Information

Organization Name

* First Name

* Last Name

* Phone Number

Alternate Phone Number

* Email Address

* Street Address of Event

* City

* Zip Code

Request Information

Please make requests at least one (1) month advance notice when scheduling your event.

* Type of Request

Schedule a fire truck appearance
Schedule a speaker
Other... This choice will expand a text box

* Preferred Time

* Number of Adults

* Number of Children

* Children Age Range

* Date of Event MM/DD/YYY

* Reason for your request / Additional information

Agreement Information

Remember: At least one (1) month advance notice when scheduling your event.

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Brevard County Fire Rescue Speaker Request Form

Contact Information

Request Information

Agreement Information

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