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Safety 101 Request

Name of your school, business or organization:

Address where the presentation will take place: 


City:    State:     Zip:

Contact name:

Contact e-mail: 

Contact phone: 

Has this facility had a Safety 101 presentation before? 

Please ensure your presentation area meets the following requirements:
Ground level  
15 ft. minimum ceiling height 
Access to an exit door or window to allow extension cords to reach our trailers in an adjacent parking lot

What is the approximate age group for the attendees? Check all that apply.
 Elementary School         Middle School          High School          Adult    

Estimated number of people who will attend the presentation:  

IPL requires a minimum of four weeks to schedule our presentations, which are given Tuesday through Thursday between the hours of 8:30 a.m. and 3 p.m. The presentation will last approximately one hour.  However, it can be formatted to your desired length.

*Please provide available dates at least four weeks from today, along with your preferred start time.


Do you have any special needs or educational topic requests?

* IPL reserves the right to cancel or reschedule presentations at any time due to inclement weather or unforeseen circumstances.