Atlanta Vol. Fire Department

Request for Fire/Medical Safety Information Form

Welcome to Atlanta VOl. Fire Dept. Safety Request

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Atlanta Vol. Fire Dept. Main Page
 Info. on Child Safety
 Info on Carbon Monoxide
 Contact Atlanta Fire Department

This form is designed to allow you to request a Fire-Medical Safety Topic be added to our Home Page.
Please answer the items that you feel comfortable answering.
Place the additional information about your idea in the comments box.
If your idea is super good we will place a link to your Emergency Department,
your organization, or to your personal Home Page. We will respond to all requests.

Any areas marked with an asterisk (*) must be filled out in order to submit this form.
If your browser does not support forms, you can email us at:
avfd@ccrtc.comhttp://www.geocities.com/Athens/Olympus/9851/

*Your Email Address

*First Name

*Last Name

Company Name

Street Address


City

State/Province

Zip/Postal Code

Country

Daytime Telephone (with Area Code)

Evening Telephone (with Area Code)

Has the existing Safety Facts helped you?

If YES, what type of organization did the safety tip apply to?
Business
Personal
Non-Profit Organization/Education Which of our existing safety facts sheets do you feel was the best help to you?

Is your Safety Request(s) Medical or Fire related:
Fire Safety Facts
Medical Safety Facts

Would you be interested in helping us write up your safety suggestion?

If applicable, what kind of service does your organization offer?

What would you like the title of your safety suggestion to be?

Who would be the target audience for this sugestion?

Do you have pictures or artwork thats not copywrited that could be used?

If not, would you like us to create them for you?

Are you interested in any of the following as topics to be added? (You may check all that apply.)
School Bus Safety
Holiday Safety Tips
Hotel Fire Safety
Basic First Aid Tips
CPR Tips
What the Medics would like you to know before we get there

If there is any other information about your safety suggestion, you, or your company that you would like us to know please feel free to type it in the text area provided.

Thank you for taking the time to fill out our form. One of our Firefighters or Medics will be in touch with you as soon as possible.

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