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: *
Your answer
Event Start Date: *
MM
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YYYY
Event Start Time: *
Time
:
Event End Date: *
MM
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DD
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YYYY
Event End Time: *
Time
:
How many individuals are expected to attend? (To include your event staff) *
Your answer
Please provide a description of the event and activities: *
Your answer
Is this event occurring on multiple days? *
Point of Contact for Event: *
Your answer
Point of Contact Phone Number: *
Your answer
Point of Contact E-Mail Address: *
Your answer
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