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Georgetown EMS Standby Request Form
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Email
*
Your email
Name of organization requesting EMS services?
Your answer
What type of support would you like?
2 EMT First Responding (Must be at least 3 days In advance)
Ambulance Crew with 4 EMT's (Must be at least 7 days in advance)
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Is the organization affiliated with Georgetown University?
Yes
No
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Contact Email Address
Your answer
Location of the event
Your answer
Date of the event (mm/dd/yyyy)
Your answer
Start and End time of the event (0000-2400)
Your answer
Immediate questions or concerns?
Your answer
A copy of your responses will be emailed to the address you provided.
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