Required fields are marked with asterisks (*)

Crime Prevention Services

Presentation Request Form

Mission Statement: Together with our community based policing principles and community partners, we strive to create community safety and well-being through engaged partnerships, meaningful collaboration and relevant outcomes that collectively we all benefit.

Please fill out this form with all the required information and press the SUBMIT button to send to Crime Prevention Services.

First Name

Last Name

Street Address

City

Postal Code

Email Address

Home Phone Number (e.g. 999-999-9999)

Cell Phone Number (e.g. 999-999-9999)

Business Phone Number (e.g. 999-999-9999)

Phone extension (e.g. 1234)

Preferred Requested Presentation Date(s): (to be confirmed by officer)

Preferred Requested Presentation Time(s): (to be confirmed by officer)

Organization / Company:

Number of people Attending (minimum 20):

Contact Information:

Position / Title:

Address/ Location/ Room # of Presentation:

Do you have the necessary equipment onsite? Please list: (i.e. projector, laptop, audio system, DVD/TV, white board, smart board, table…)

Have we attended before? Select either Yes or No.

Yes

Can we assist you with any other crime prevention service? Enter any additional crime prevention questions you have?

180 Derry Road E Mississauga, Ontario L5T2Y5
Tel: (905) 453-3311 Ext: 4021

PeelPolice.ca