Please complete this form once per department or agency to help us plan food and seating for the EMS & Law Enforcement Night Out BBQ at Lexington Regional Health Center. Thank you!

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* 1. Primary Contact Name

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* 3. Agency Name (Example: Lexington Fire & Rescue, Dawson County Sheriff’s Office, Overton Fire Dept.)

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* 4. Total number of people from your department/agency who plan to attend (Please include yourself in this count.)

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* 5. Anything else you’d like us to know?

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