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COMMUNITY ENGAGEMENT
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Name
*
First
Last
Phone
*
of Attendance Name
Email
*
Name of Organization/Business/School/Event
*
Event Date
*
Event Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
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District of Columbia
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State
Zip Code
Start Time
*
End Time
*
Type of Request (Check all that apply)
*
Ambulance visit + demo (View inside and outside of the ambulance and a crew can demonstrate an overview of EMS, equipment, CPR etc)
Tour of Medic Headquarters Guided Tour of Medic’s Headquarters on Wilkinson Blvd (Including our 911 call center and ambulance bay)
CPR & AED Training (Hands only non-certified) Recruitment table or display for career fairs)
Other
If you selected "Other" above, please tell us about your request...
Number Expected in Attendance Ages 0-17
Number Expected in Attendance Ages 18+
Additional Information (Parking instructions, etc)
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