City of Charlotte

corporatecommunications1@ci.charlotte.nc.us

600 East Fourth Street, , Charlotte, NC, 28202, US

704-336-7600

CMPD Active Survival Training Request Form

NOTE: To have this form translated into another language, right click the form and select the langauge needed.

Contact Name

Contact Phone Number

Contact Email Address

Name of Sponsoring Organization

Type of Organization

Business

School / University

House of Worship

Bar / Lounge

Other

Description of Other Type of Organization

Number of Attendees

0-20 people

21-50 people

More than 50 people

Has this location hosted a presentation before?

Yes

If you have hosted a presentation before at this location, when was it held?

What month would you want to host this training

Specific Day of the Week to hold this training

Time of the Day to hold this training

Do you have a projector or large TV for this presentation?

Yes

Does your projector/TV have an HDMI or VGA connection?

Yes

Do you have equipment to amplify sound?

Yes

Do you need a Spanish Officer to conduct your training?

Yes

Document Signers