Aetna EMS Crew Request Form
Please use this form to request an EMS standby for an event. You may either request an ambulance, bike team or both. A representative from Aetna's EMS division will contact you as soon as possible.

Please note there is a $100 an hour charge for a committed ambulance or bike team.
Name *
Your answer
Organization
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Date of Event *
Your answer
Time of Event: *
Your answer
Expected Duration: *
Your answer
Standby Type *
Please note there is a $100 an hour charge for a committed ambulance, gator crew or bike team.
Required
Additional Information
Your answer
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