Event/Landing Zone Safety Education Request

Please complete all information below and submit the form to initiate the request.
PLEASE NOTE: You will be contacted via e-mail within 5 business days to discuss your event. All requests must be submitted at least one week in advance of the requested date.

All fields are required.

General Information Type of Request Requesting Agency Contact Person Email Address Contact Phone Number (Area Code Required) Cancellation Number (Number our communications center can call in the event our crews are not able to attend. A cell phone number is preferred.)

Event Class Information Date If this is an event, please indicate the type of event If this is a class, please indicate the location of the class City/Town County What time would you like the Helicopter/Mobile ICU to arrive? For class, indicate class time (Please allow 2 hours)

Landing Zone Information Where will the helicopter land? Address/Crossroads Location and type of surface landing area Any obstructions? Radio frequency PL Tone Ground contact unit number Please describe your request in detail and state if another air service will be in attendance:

MyAtriumHealth

Event/Landing Zone Safety Education Request