Memorial Event - Online Registration

I. Agency Information:

Department Name
Contact Name
Contact - Phone
Contact - Pager
Contact - Cell
Contact - Email

2. Will your department be participating this year?

Yes No

Will your display be manned?

Yes No

Please describe the equipment that you plan to display below:

Such as vehicle(s) make, model and year. Please note any special set-up/display needs to include floor space requirements for larger displays.

Please list local family oriented talent from your community or department that you would like to see perform at this year's event:

Such as police K-9 Unit, School Jazz Band, or Choir. Please list organization name and point of contact information.

Will you need display tables? If Yes, How many?

Yes No

Please ensure that you plan to use the tables you have requested. NIPMW is responsible for the cost of the tables to include skirting.

3. Kick-Off Breakfast

How many people will be represented from your agency?

Please confirm the exact number of participants prior to submitting your registration. Guests should include Sheriff, Chiefs, Dignitaries, and Officers participating in your display.

Please list the name and title of those who will be attending the Kick-Off Breakfast below:

Department Name

Agency Director (Chief/Sheriff)

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4. Please list questions or suggestions: