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2. First Name
3. Last Name
5. Contact information for questions
   Phone number and email of requesting person
7. Department Requesting
   -- Select One --Atoka VFDCottonwood VFDHappy Valley VFDJoel VFDLa Huerta VFDLoco Hills VFDMalaga VFDOtis VFDQueen VFDRiverside VFDSun Country VFDEddy County Search and RescueEddy County Fire Service AdministrationLovingHopeCarlsbad FDArtesia FDOther

   Select department name requesting class.
9. Type of course

   1. CPR
   2. Communications
   3. Command, Control, and Accountability
   4. Driver Operator
   5. EMS
   6. Extrication
   7. Fire
   8. Fire Extinguisher
   9. Firefighter Safety and Survival
   10. Hazmat
   11. Investigation Awareness
   12. Pump Operations
   13. Wildland
   14. Other
11. Specify Course Request
    In Detail explain your request from above. If other put course type requesting and details of needs.
13. Total number of Students planned
15. Date/Time of Training
    Date/Time of Training

    Date/Time of Training
    Please insert Date/Time for the course requested.
17. Location of Course
    Please give physical location and address of where you would like the class to be instructed.
19. Instructor Needs
    Explain what the instructor will need to bring. ie Computer, projector, etc.
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

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