Community Event Request

Stewardship.

As part of our Corps Values, HCEC believes that we are accountable to the community to use our resources wisely. This also means holding ourselves responsible for sharing our resources with the community. HCEC is proud of being involved with and giving back to the community. If you would like HCEC to provide education, awareness resources, or participate in a community event, please fill out the form below.

Community Event request of an ambulance or HCEC personnel

Please fill out this form in its entirety.

Name*
First Last
Email*
Enter Email Confirm Email
Phone*
Name of Organization*
Type of Event*
Name of Event
Date of Event*
MM slash DD slash YYYY
Start Time of Event*

: Hours

Minutes

AM/PM
End Time of Event*

: Hours

Minutes

AM/PM
Address of Event*
Street Address Address Line 2 City State ZIP Code
Estimated Attendance at Event*
This is to give us an idea of the amount of resources to bring.
Services Being Requested*
How were you referred to HCEC?
Event Description/Notes*
Please provide a brief description of the event and the requested services, as well as any additional notes.
Name
This field is for validation purposes and should be left unchanged.

Stewardship.

Community Event request of an ambulance or HCEC personnel

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