Request for use of Pyrotechnics before a proximate audience

Name of person, department, or organization sponsoring the production:

Primary contact name:

Primary contact email:

Primary contact phone:

Date and time of the production:

Exact location of the production:

Please be as specific as possible when it come to explaining the location.

Number and types of pyrotechnic devices and materials to be used:

Person in charge of firing pyrotechnics:

Pyrotechnics license ID (if applicable):

Qualifications/experience of the pyrotechnics operator(s):

Operators experience with these pyrotechnics:

Names and ages of all assistants who will be present:

Explanation of the general responsibilities of the assistants:

Point of on-site assembly of pyrotechnic device(s):

Manner and place of storage for the pyrotechnic materials and device(s):

Certification that the set, scenery, and rigging materials are inherently flame retardant or have been treated to achieve flame retardancy:

Certification that all material worn by performers in the fallout area during the use of pyrotechnic effects shall be inherently flame retardant or has been treated to achieve flame retardancy:

Please attach a diagram of the facility where the production is to be held.

One file only.
50 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, avi, mov, mp3, ogg, wav, bz2, gz, sit, svg, tar, zip.

Please attach a copy of the MSDS (material safety data sheet) for the pyrotechnic(s) to be used.

One file only.
50 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, avi, mov, mp3, ogg, wav, bz2, gz, sit, svg, tar, zip.