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Standby/Public Event Request Form
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We love interacting with the public and would like to make your next event a safe one.
Name/Organization
*
Primary Contact
*
First
Last
Email
*
Enter Email
Confirm Email
Phone
*
Best Method of Communication
*
Email
Phone
Start Date of Event
*
MM slash DD slash YYYY
Start Time of Event
*
:
HH
MM
AM
PM
AM/PM
End Date of Event
*
MM slash DD slash YYYY
End Time of Event
*
:
HH
MM
AM
PM
AM/PM
Standby/Event Type
*
Athletic Race/Event - EMS Standby
Large Gathering - EMS Standby
Public appearance/demonstration
Private CPR Class (large groups)
Other
Services needed
*
To select multiple options, hold down your Control or Ctrl key.
EMS Standby Ambulance (BLS unless otherwise specified)
Advanced Life Support (ALS) provider (specific requirements)
First Aid Station
EMS ATV team (rough terrain)
EMS bike team
EMS walking teams
Display ambulance (not available for emergencies)
Instructors
Members to interact with public (at community event)
Event Description
*
Comments
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