Please complete the following information.

Type of Request

Neighborhood watch Crime Prevention

Alcohol/Drug/Tobacco Other

Contact Information

Contact Name:

Organization Name:

Address:

City:

State:

Zip:

Phone Number:

Email Address:

Group Information

Number of persons in Group:

Date/Time of requested presentation:

Special needs, requests, or considerations should be listed here. Also include the location of the event if it is different than listed above. If you have requested other agencies (i.e. Bartlett Fire) to attend please let us know as we may be able to coordinate our efforts to better suit your needs. Please note that all information is kept private and held on a secure server database. We will never sell or release the information.

Requests must be submitted at least Two weeks prior to the date of the event in order for adequate preparation for the meeting. Special consideration will be given to those whom have valid reasons for shorter notice.

The Police Department will contact you by phone to confirm your request. Any further questions, call (901)-385-5510