Water Conservation Participation Request Form

In order to adequately staff Events/Presentations, all requests must be received at least two (2) weeks prior to the event date.

Type of participation request:*

Event

Speaking engagement/presentation

Children’s event or presentation

NOTE FOR CHILDREN’S PRESENTATIONS: For liability purposes and to ensure an orderly environment, City of Dallas Water Conservation requires your staff to be present at all times during the requested presentation(s). Failure to have staff present will prevent City of Dallas Water Conservation from making or continuing the presentation(s).

Name of event:*

Sponsoring organization(s):*

Location/venue name:*

Location address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Start date of event/presentation:

Date Format: MM slash DD slash YYYY

End date of event/presentation (if more than one day):

Date Format: MM slash DD slash YYYY

Purpose of event/presentation:*

Start time:*

:
HH

MM

End time:*

:
HH

MM

Primary age group of those attending:*

Adults

Children

Both

If the primary age group is children, what is the age range/grade level(s)?*

Name of contact person:*

Contact telephone:*

Contact e-mail:*

Event website (if applicable):

Anticipated attendance (based on previous attendance or estimate):*

Will the event/presentation be held indoors or outdoors?

Indoors

Outdoors

Will a table and chair be provided?

Yes

No

Table only

Chair only

If an exhibit booth is to be provided, what is the booth size?

If indoors, will any of the following equipment for a PowerPoint presentation be provided?

Laptop

Data projector

Power outlets/extension cord

If outdoors, will a pop-up tent be provided?

Yes

No

Is this the first year for this event?*

Yes

No

Not Sure

Has City of Dallas Water Conservation participated at this event or presented to this group in the past?*

Yes

No

Not sure

Are other City of Dallas departments participating?*

Yes

No

Not sure

Is a Spanish-speaker needed?*

Yes

No

Other information you wish to provide (e.g., set-up, move-in and move-out procedures, etc.):

FOR SPEAKING ENGAGEMENTS ONLY:

Desired topic of presentation:

General water conservation

Outdoor water conservation

Indoor water conservation

Desired length of presentation (minutes)?