Johnston County Emergency Services - Event Public Relations and EMS Unit Coverage Request

Johnston County Emergency Services - Event Public Relations and EMS Unit Coverage Request

Please fill out this form to request Johnston County Emergency Services at an event. For more information, email JCESevents@johnstonnc.com.
Requester's Name*
Person and Organization (If Applicable)
Name of Person Completing This Form*

First NameLast Name
Name of Primary Contact*

First NameLast Name
Primary Contact's Phone Number*

Area CodePhone Number
Primary Contact's Email*
example@example.com
Name of Event*
Educational Visit or Medical Coverage*

Educational Visit / Public RelationsMedical Coverage
Location/Address of Event*

Street Address

Specific Location/Area within Address (Optional)

Town

Zip Code
Date of Event*

MonthDayYear
START Time of Event*

:HourMinutesAM/PM Option
END Time of Event*

:HourMinutesAM/PM Option
Brief Description of Event*
Estimated Number of Attendants*
Estimated Number of Children Attending (If Applicable)
Will there be anything provided to the staff in attendance (tables, chairs, etc.)? If so, please provide a list of those items here.
Should be Empty: