KAUAI POLICE DEPARTMENT
REQUEST FOR SERVICE
PH: (808) 241-1669 • www.kauaipd.org • rgreen@kauai.gov

REQUIREMENTS FOR REQUESTING SERVICE

• Please submit requests at least four weeks prior to event.
• Please submit a new form for each speaker request or service request.
• The event shall be open to the public and free of charge, not be political in nature, and meet the ethical guidelines set forth by the County of Kauai.

* Due to manpower limitations, we may not be able to accommodate all requested dates.

* indicates required field

REQUESTOR INFO

Name
Organization
Address
Event Location * (Enter 'same' if same as above)

CONTACT INFO

Name *
Phone	(as ###-#### or ###-###-####)
Best time to call
Email

TYPE OF SERVICE REQUESTED

Type of Request	SPEAKERSERVICE
Other topic or service
Requested Date
Requested Time	AM PM
Number of Attendees	(as # or ## or ### or ####)
Ages (if under 18 yrs)
Special Requirements or Additional Information