Event Coverage Request Form
**Disclaimer: All requests should be made at least 30 days prior to the event. The more time you give us, the better the chance of us being able to cover it.**
Today's Date
Your Full Name
Your Full Address
Your Contact Phone Number
Your Email Address
What Type of Event is this for?
Are we demonstrating the ambulance (giving tours to children) or solely providing EMS coverage or both?
Approximately how many people will be at this event?
Where is this event taking place (address)?
What date is this event taking place?
What time will our services be needed?
What time will the need for our services conclude?
When is the latest you need to know if we can provide services for this event?