YOUR CONTACT INFORMATION:
Full name:
Company Name:
Email address:
Telephone number:
Location of Event:
Date(s) and Time(s)s of Needed Service:
Check the box(s) for which services you are requesting for your event. For a description of each choice, please refer to our SERVICES link on the left hand column. Select # of MICU Ambulances 1 2 3 4 Select # of BLS Ambulances 1 2 3 4 Select # of Bike Medics 1 2 3 4 Select # of First Aid Teams 1 2 3 4 5 Select # of EMT's Requested 1 2 3 5 6 7 8 9 10 Select # of Water Safety Personnel Requested 1 2 3 4 5 6 7 8 9 10 10+ Medical Gator (no staff included) Jet Ski Team (2 Jet Ski's w/ 2 Water Safety Medics)
Briefly describe what type of event you are putting on and any specific requests that you have: