Educational Demo Request an Educational Demo Fill out the form below to request EMSA at your event. During this visit, an EMSA medic can provide tours of the ambulance's interior and exterior, demonstrate the use of various types of equipment kept in the ambulance, and answer questions related to EMS and EMSA operations. This is a free service for community members and is only offered within the EMSA-regulated service area. Requests are scheduled on a first-come, first-served basis and must be submitted at least 30 days before the event. For large or multi-day, resource-intensive events, requests should be submitted no later than 60 days before the event. EMSA is unable to fulfill all requests and reserves the right to decline any event request. Your event is not confirmed until you receive a confirmation email from EMSA’s Community and Special Events Coordinator. Important: EMSA educational demonstrations cannot use their ambulance to transport patients. If you need this service, please visit our medical standby page. If you have not heard from EMSA regarding your request within 10 business days of making the request, please contact [email protected]. If you do not see a confirmation page or receive a confirmation email, your entry has not been submitted.Event Name*Multiple Dates This event includes multiple dates Please list all dates*DateTime Date of the Event* MM slash DD slash YYYY Start Time (At what time should the EMSA ambulance and medic be onsite)* : Hours Minutes AM PM AM/PM End Time (What time do you expect the EMSA ambulance and medic to be released from the event)* : Hours Minutes AM PM AM/PM Is your event date flexible?* Yes No Please choose two additional dates in case your first request isn't available.Second choice date* MM slash DD slash YYYY Third choice date* MM slash DD slash YYYY Organization Name*On-Site Event Contact Name (Preferably someone available throughout the event)* First Last Phone*Email* Name of Venue*Are there specific driving instructions for entering the event site?Where should our ambulance park?Where will the medic/crew be stationed if they are not with the ambulance?Estimated Attendance*Venue Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Estimated Age of Attendees*How can we explain this event to the EMSA Team Member who will represent us at your Educational Demonstration (mission of host organization, desired outcomes from event, description of expected attendees, etc.)?Event Documents (map, schedule, or other relevant materials) Drop files here or Select files Max. file size: 50 MB. By checking this box, you acknowledge:* Event requests not received within 30 days advance notice may be unfulfilled due to system capacity.By checking this box, you acknowledge:* that system levels may force EMSA to cancel their appearance unexpectedly to devote resources to its 911 system.CAPTCHA