Program Speaker Request

Use this form to request a program about safety, careers, guest speaker, etc. Please complete the form in its entirety and submit it at least 14 days prior to your requested program event date. Please call us with questions at 843-757-2800 ext. 3516.

Program Information:

Program Requested (select one)*

Date Of Event (xx/xx/xxxx)*: Start Time*: End Time*: Total Time:

Address of Event*: City: State: Zip:

Appriximate Number Attending: Age Group*:

Contact Information:

Primary Contact*: Phone*:

Mailing Address*: City*: State*: Zip*:

E Mail*: Fax Number:

Comments/Special Instructions:

Disclaimer: Submission of this form does not guarantee participation by the BTFD in your event, grant permission for use of the Department name or logo in any advertisement, or connect the Department in any manner to your event. All requests submitted and received 14 days prior to the event will be evaluated in a timely manner. We will contact you in the event of a conflict and suggest an alternative date or substitution.