Please fill out this form if you would like to request the Lehigh University Police to do a program for your residence or group.

You must submit your request three (3) weeks prior to the date you would like the program presented.

	Name:	(required)
	Phone #:	(required)
	Address:	(required)
	E-mail :	(required)
	Title:	(required)
	* Title (house president, gryphon, etc.)
	Date and time you would like program presented: (required)
	Date:	Time:
	Number of people expected at program: (required)
	Please tell us what type of program you would like presented, i.e., alcohol related, safety related, etc.: (required)