Western EMS Coverage

Western EMS Coverage

If you are planning an event and would like EMS coverage, please fill out the form below. Please submit as much information as you can.
Event Organizer Name*

First NameLast Name
Department/Organization*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Event Title*
Event Type*
Event Location*
Event Start Date and Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Event End Date and Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Coverage times are the times that you would like EMS to be present. Please estimate what time the crowd will arrive and disperse.
Coverage Start Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Coverage End Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Event Description*
Approximate Number of Attendees*
Do you want a staffed medical station?*
If no, WEMS personnel will walk around the event. If yes, you must be able to provide a room or booth for our crew and equipment.
Location of medical station*
if applicable
Has University Police been requested?*
Has Lifeguard Ambulance Service been requested?*
Any additional information you would like to provide
Once submitted, we will contact you to personally acknowledge receipt within 48 hours. You may email us at Western-EMS@wiu.edu with any questions.
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