Please print and fill out this form and fax it to Drug Demand Reduction at 904-823-0173

Drug Demand Reduction 

Event Support Request  

Please complete as much Agency and Event information as possible to assist us in accurately supporting your event.

Please ensure you sign at the bottom of the form after you complete the information.

DDR FAX NUMBER:  (904) 823-0173

DDR MAILING ADDRESS:  Florida National Guard, ATTN: DOMS-CD-DDR, P. O. Box 1008, St. Augustine, Florida 32085-1008

DDR OFFICE PHONE:  (904) 823-0163 / 0167 / 0355

AGENCY INFORMATION

DDR USE ONLY

NAME

MSN NUMBER

ADDRESS

RECEIVED BY

Conference Type

DATE RECEIVED

Contact

MSN POC

EVENT INFORMATION

Location and address of event

START  Date

END Date

Attendees#

Time

Time

 Please provide a narrative of the support

desired from DDR so we may properly support your event

Agency Representative   ___________________________          _____________________________________

 (Signature)

(Printed Name)

DDR Representative         ___________________________            _____________________________________

(Signature) 

(Printed Name)