First Responder EV Awareness Program Application

APPLICATION

First Responder EV Awareness Program

Please complete the application below to request an EV safety awareness program for your firefighters.

We will contact you to setup a date and time for the program.
Contact Person*

First NameLast Name
Job Title*
Employer/Organization*

Company Name

Street Address

CityState

Zip Code
Phone Number*
Email*
example@example.com
Organization Type*

Fire EnginePoliceMedicalOther
Indicate Funding Source*

VolunteerMunicipalCountyOther
Need Sustainable Jersey Points?*

YESNO
EV Incidents Experienced*

CrashRoad FireHome FireNone
Preferred Time for Program?*

Weekday 7pm - 9:30pmSaturday 8am - 12noon
Should be Empty: