Mediaid Emergency Medical Service

An Independent Voluntary Organisation

 

Event Request Form

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You are advised to read the Terms Of Booking prior to completing and submitting this form!

 

I./ We request that Mediaid provide First Aid Cover at the following event:

 

Date:              

Start Time:                Finish Time:

Address Of Event:

 

County:

  

Postcode:

   (Please make sure you include the Postcode)

Type Of Event:        

 

Name Of Organisation Making Request:

Name Of Organiser:

Address:

County:

Postcode:

Telephone No.

Fax No.

Mobile No.

E-Mail:

 

 Nearest Hospital:  

Address:

County:

Postcode:

 (Please make sure you include the Postcode)

Telephone No.

The above hospital must ha an Accident and Emergency Department which is open for the duration of your event!

 Does your event require an Equipped Ambulance? (tick for yes)

What  are your staffing requirements?

Unsure! Call for assistance!

 

  May we do a collection? (tick for yes)                                                    

 Will a meal or lunch be provided? (tick for yes)                                    

 Will liquid refreshments be provided? (tick for yes)                             

Other Information

By submitting this form your are agreeing to the terms and conditions of booking

remember this is merely a request form and in no way constitutes a confirmed booking 

 

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Last Updated 15 April 2008