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2. Event Information

   Thank you for your interest in dedicated EMS coverage for your event.

   
   

   Important Information: 

   -Multiple factors determine whether we can offer coverage for a given event.

   -Not all events submitted will receive offers for coverage.

   -Submitting this form DOES NOT guarantee coverage.

   -For follow-up information, email us at EMSEvents@onslowcountync.gov 

4. Event Name:
6. Event Date:
8. Event Start Time:
9. Event End Time:
10. Time EMS Unit Should Arrive:
12. Event Address:
14. Address
16. City
17. State
18. Zip Code
20. Briefly Describe The Event:
22. Tell Us About The Event Contact Day Contact Person
24. First Name:
25. Last Name:
27. Contact Cell Phone:
29. Contact Email Address:
31. Tell Us About The Organization
33. Organization Name:
35. Person Responsible For Invoice:
37. Phone Number:
39. Address for Invoice:
41. Address
43. City
44. State
45. Zip Code
47. Email For Invoice:
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field