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Traffic Safety Program Request

For information about presentations available through the Secretary of State's office, please visit the Traffic Safety Presentations section.

School/Company/Organization *

Address of Event *

City *

ZIP Code *

County *

Telephone Number *

Best Time to Call

E-mail Address *

Contact Name *

Adult Presentation

Desired Date of Presentation

Time

Approximate Attendance

Special Instructions

Child Passenger Safety Presentation

Child Passenger Safety Presentation
Parents/Caregivers

Desired Date of Presentation

Time

Approximate Attendance

Special Instructions

DUI Classroom Presentation

Classroom Presentation

Desired Date of Presentation

Time

Approximate Attendance

Special Instructions

Middle School Traffic Safety

Classroom Presentation
School Assembly

Desired Date of Presentation

Time

Approximate Attendance

Special Instructions

Teen Drinking and Driving Prevention Presentation Available for Grades 9-12

Classroom Presentation
School Assembly

Desired Date of Presentation

Time

Approximate Attendance

Special Instructions

Youth Traffic Safety Presentation Available

Bicycle and Pedestrian Safety (grade 2)
Toby Tire School Bus Safety (grades K-3)

Desired Date of Presentation

Time

Approximate Attendance

Special Instructions

*Required

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