Medical Standby Request Type of Request*Ambulance and Full Crew $100/hrEMT Only (no ambulance) - $50/hrWhat kind of event are you planning? Date of Event? MM slash DD slash YYYY Time requesting an ambulance to be on site? : Hours Minutes AM PM AM/PM Time requesting an EMT to be on site? : Hours Minutes AM PM AM/PM Anticipated time the event will end? : Hours Minutes AM PM AM/PM Address of event? Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Approximate number of attendees at the event?Will there be alcohol served? Yes No Contact Person Name* First Last Email Address* Best contact number?*Cell phone number?
