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Dedicated EMS Standby Request Form

  1. 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 

  2. Event Address:
  3. Tell Us About The Event Contact Day Contact Person
  4. Tell Us About The Organization
  5. Address for Invoice:
  6. Leave This Blank:

  7. This field is not part of the form submission.