community event form Community Event Request Event InformationStandby Type- Select -Medical Standby - Race/TriathlonMedical Standby - SwimMedical Standby - Sporting EventMedical Standby - ConcertNon-Medical Ambulance DemonstrationEvent NameDate of EventEvent Start TimeTime Ambulance Should ArriveEvent End TimeEvent HolderEvent LocationOrganizations InvolvedLocation for Ambulance to Report to# of Ambulances?Approx. # of ParticipantsParticipant Age RangeSpecial Instructions for EventBilling InformationPreferred Billing Type- Select -Check (mailed to HQ ambulance billing with bill)Credit Card (including fees)Billing NameBilling PhoneBilling AddressIs this for a for-profit or a nonprofit organization?Is this for a for-profit or a nonprofit organization? For Profit NonprofitTax Exempt ID# (if applicable):Contact Prior to EventContact PhoneContact EmailComments/QuestionsSubmit
