Events Coverage Request Form
Please fill out this form if you are requesting EMS coverage from the Washington University Emergency Support Team. This information will allow us to better allocate resources in order to best cover your event.

Please be aware that in every event Washington University Emergency Support Team provides coverage to, a location, which includes a table and chairs, is required to house our medics and their equipment.

Organization or Event Requesting Coverage *
Your answer
Name of Contact Person of Event or Organization *
Your answer
Phone Number of Contact Person *
Your answer
Email of Contact Person *
Your answer
Location of Event *
Your answer
Date of Event *
MM
/
DD
/
YYYY
Start Time of Event *
Time
:
End Time of Event
Time
:
Duration of Event *
Your answer
Description of Event *
Your answer
Number of People Attending Event (including staff personnel) *
Your answer
Number of Medics Requested *
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