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Request Event Coverage from CU EMS
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Name
First
Last
Email address
Phone number
Are you requesting EMT or Wellness Ambassador coverage?
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EMT
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Wellness Amabassador
Event Name
Start Date & Time
End Date & Time
Location
Expected attendance
Event type
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Athletic event
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Concert/performance
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Conference/Meeting
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Festival/fair
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Orientation/tour
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Other
Enter other…
Risk factor(s)
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Alcohol present
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Outdoor event
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High attendance (500+)
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Physical activity
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Extreme weather possible
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Late night (after 10 p.m.)
Special considerations
