If you prefer, you can print out this form, complete and return it to:

PARC Task Force, Inc.
515 W. Moreland Boulevard
Room CG72
Waukesha, WI 53188
(262) 896-8026
(262) 786-8787 fax

PRESENTATION REQUEST
Date:
Name:
Title/Affiliation:
Street Address:
City: County:
State or Prov.: Zip/Postal Code:
Country:
Email Address:
Telephone #: Ext.
Fax #:

We would like a presentation:
(please check one)

about the PARC Task Force

about Tips for Parents

about the DS2 Program (registration form)

about the PARC Youth Group (coming soon)


Requested dates

Location

Additional Information to assist us in your request:

In 1999...
38 % of the total traffic fatalities were alcohol-related. This is 1 fatality every 33 minutes.



Membership Application
Donor Application
Request for Information
Request for Presentation
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