Berrien County Emergency Medical Services
519 County Farm Rd, Nashville GA 31639
229-686-5779
Request Ambulance Standby for Event
Please submit request at least 45 days in advance of event.
Submission of this form is only a request and not a guarantee of coverage of your event. Someone will contact you to confirm.
Submit form in person, by fax (229-686-7614) or email to gsumner@berriencountyga.gov
Organization Name
*
Organizer Name
*
First Name
Last Name
Organizer's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of Event
-
Month
-
Day
Year
Date
Times and additional dates
What is the type of event you are requesting an ambulance standby for?
Educational Institution(Career Fair, etc)
Sporting Event (football, softball, etc)
Public Event
Other
Address of Event
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Describe your event
Anticipated Attendance
*
0-50
50-100
100-250
Over 250
Contact Information for someone on site the day of the event
Name (Must be on site day of event)
*
First Name
Last Name
Phone Number (Must be on site day of event)
*
Please enter a valid phone number.
Submit
Should be Empty: