Required fields are marked with asterisks (*)

Public Relations Request Form

Essex-Windsor Emergency Medical Services makes every effort to attend all public relations requests, however, attendance is often dependent on the availability of staff and ambulances.

It is recommended that you provide at least 4 weeks advance notice for your event.

If you would like to request Essex-Windsor EMS attend your special event, please fill out this form and an Essex-Windsor EMS representative will contact you within 72 hours.

Please note, this is for public relations only and is not a request for medical coverage. if you would like to request dedicated medical coverage for your event, please use our "Medical Coverage Request" form.

Event Information

Date of Event:

Event Start Time:

Event End Time:

Have we attended your event before?

Yes

Name of Event:

Location of Event:

Event Description:

On scene contact name:

On scene contact number:

Reporting Location:

Ambulance Area (if applicable):

Event Type:

Safety Village Tour

School / Classroom Request

Public Event

Private Event

Parade

Grand Opening

Festival/Fair

What are you requesting?

Ambulance

Paramedic

Bike Patrol

District Chief

Deputy Chief

Chief

1 Kubota (ATV) with 1 Paramedic

EMS Station Visit

"Siren" our Essex Windsor EMS mascot

Contact Information

This information will be used to contact you about your event. Please be sure to accurately complete all fields.

Event Organizer Name (Company Name):

Event Organizer Address (Company Address):

Contact Name:

Contact Phone Number:

Extension (if applicable):

Contact Email:

Comments:

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Public Relations Request Form

Event Information

Contact Information