Police Guest or Speaker Appearance Request

2. Instructions
   If you would like a Dayton Police Officer to be a guest or a speaker at your upcoming event, please fill out this request form AT LEAST TWO WEEKS prior to the event. We ask that you provide details about the event, speaker/guest requirements, agenda or itinerary. This is also applies for requesting officers to bring equipment for display at your event. You will be notified as soon as possible regarding your request.

   If you would like a Dayton Police Officer to be a guest or a speaker at your upcoming event, please fill out this request form AT LEAST TWO WEEKS prior to the event. We ask that you provide details about the event, speaker/guest requirements, agenda or itinerary. This is also applies for requesting officers to bring equipment for display at your event. You will be notified as soon as possible regarding your request.

4. REQUESTOR INFORMATION:

6. Sponsoring Organization*

7. Organization Website

9. Point of Contact Name*

10. Contact Email Address*

12. Organization Address

14. City

15. State

16. Zip Code

18. Contact Phone Number*

19. Contact Fax Number

23. EVENT/PROGRAM DESCRIPTION

25. Event Name*

26. Estimated Attendance*

28. Theme / Purpose / Brief Description *

30. Onsite Contact*

31. Onsite Contact Cell Phone Number*

33. Event Date/Time*
    Event Date/Time Start Date

    Event Date/Time Start Time

    —

    Event Date/Time End Date

    Event Date/Time End Time

34. Event Type*
    -- Select One --Public EventPrivate EventIndoor EventOutdoor EventFormal/Gala Event

    Choose all that apply to your event

36. Time Officer(s) Would Attend*

37. Venue Name & Building/Room Number*

39. Venue Address*

41. Type(s) of Services/Equipment Requested*

43. Media Invited

    1. Yes
    2. No

Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field