LifeLink Air Landing Zone Class / Public Relations Event Request
Date of Event
*
-
Month
-
Day
Year
Date
Start Time of Event
*
Hour Minutes
AM
PM
AM/PM Option
End Time of Event
*
Hour Minutes
AM
PM
AM/PM Option
Requesting Agency or Organization
*
Contact Person
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Event Location Address and County
*
Number of People Expected
*
Aircraft Requested
*
Aircraft
Ambulance
Both
Other Aircraft, Ambulances, Apparatus Expected
*
Lecture Site Physical Address
*
Landing Zone Physical Address
*
Ground Contact Identifier
*
Example "Chief 2" or "Engine 302"
Radio Frequency Landing Zone Class
*
Normally this is LZ West, LZ Central, or LZ East, unless a special frequency exists for the agency.
Contact Person at Event
*
First Name
Last Name
Contact Phone Number of Person at Event
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email of Person at Event
*
example@example.com
Other Comments or Questions
*
Submit
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