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Public Education and Special Event Request Form

  1. Thank you for your interest in the Moline Fire Department. Please use this form to submit your request. We will contact you upon receipt.

  2. Is this for a school?*

  3. Location of Event

  4. Please let us know the date and time you are requesting. We will do our best to accommodate based on call volume and department training.

  5. Please give a brief explanation of the event.

  6. City of Moline Fire Logo

  7. Leave This Blank:

  8. This field is not part of the form submission.