Medical Division Request
If you are in need of an Emergency Medical Services Team to standby at your event, please answer the following questions to the best of your ability.
Do you, yourself, consider this event to be a “high-liability”? *
Event Name: *
Event Start Date: *
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Event Start Time: *
Time
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Event End Date: *
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Event End Time: *
Time
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How many individuals are expected to attend? (To include your event staff) *
Please provide a description of the event and activities: *
Is this event occurring on multiple days? *
Point of Contact for Event: *
Point of Contact Phone Number: *
Point of Contact E-Mail Address: *
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