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Special Event Ambulance Coverage

Ambulance coverage is available for special events. Please fill out the form below if you wish to make a request. Staffing, equipment and availability will have to be confirmed once we receive the form. We will contact you to discuss any special needs and to confirm your event.

Special Event Request Form (* = required fields)
Event Name*: 
Location*: 
Date of Event*:
Start Time*:
 
End Time*:
 
Event Location and Contact Information
Address*: 
City*: Postal Code*: 
Contact Name*: Contact Phone Number (123 456-7890)*:  
Email*:  Type of Coverage Needed*:

 
Additional Information

Please enter the code above in the text box below.
Code*:
                                      

Medavie EMS Group of Companies
Managed By NB EMS
Managed By EMC