COMMUNITY POLICING DIVISION

SPECIAL ACTIVITY REQUEST

PLEASE TRY TO PROVIDE 2 WEEKS NOTICE TO ACPD PRIOR TO EVENT

COMMUNITY EVENT

This special activity will be evaluated for approval based on relevance to law-enforcement/education, audience, time required and resources available to ACPD at time of request.

Today's Date: 1/6/2009
Receiving Request: Diana Edwards
* = Required Fields
 * Requesting Party:   
* Organization:   
Phone Number(s): 
(AAA-NNN-NNNN)		 Primary *  
 Alternative 1 
 Alternative 2 
* Mailing Address:   

,   City, State, Zip  
Email Address:   
   
* Date of Event:  Start Date: 
(MM/DD/CCYY)		  
End Date:(MM/DD/CCYY)    
Flexible?  
* Time of Event:  Start Time:
HH:MM
(12 hour format)		    
End Time:
HH:MM
(12 hour format)		    
Flexible?
* Address/Location of Event: 
(for example, 1600 5th Street, Room A)		  
   
* Number of participants:          Approximate Age group:    
   
* Requested Activity:  





Explain if Other:   
 
                                          
 
If you have not received confirmation of your request within 1 week, please contact:             
Diana Edwards, Community Relations Coordinator                         
434.972.4079