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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?
EMT
Wellness Amabassador
Event Name
Start Date & Time
End Date & Time
Location
Expected attendance
Event type
Athletic event
Concert/performance
Conference/Meeting
Festival/fair
Orientation/tour
Other
Enter other…
Risk factor(s)
Alcohol present
Outdoor event
High attendance (500+)
Physical activity
Extreme weather possible
Late night (after 10 p.m.)
Special considerations
