MedFlight Fly-In Event 2020
Email address *
Event: *
Facility in Charge: *
Primary Contact Name / Title : *
Primary Contact Phone Number : *
Secondary Contact Name / Title : *
Secondary Contact Phone Number : *
Radio Frequency:
Date Requested : *
MM
/
DD
/
YYYY
Time Requested : *
Time
:
Audience Type : *
Requested Aircraft Arrival Time : *
Time
:
Description Of Event: *
Location Address: *
Location coordinates (Preferred format is Degrees; Minutes. ie N 41' 59.29 W 086' 07.37 : *
Nearest Cross Roads : *
Type of Landing Zone: *
Hazards to report : *
Landing Zone Contact: *
Any other information or Comments:
If you are having difficulty with this form:
Contact Mark Berger; Office: 574.780.1260 or mberger@beaconhealthsystem.org
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