First Responders Special Events Contact Form

Please complete the special event request form below at least 21 days prior to your event. Email uwpdfr@mhub.uwpd.wisc.edu if you have questions.

YOUR NAME

DEPARTMENT/ORGANIZATION

MOBILE PHONE NUMBER

EMAIL ADDRESS

LOCATION OF YOUR EVENT

BRIEFLY DESCRIBE YOUR EVENT

DATE OF YOUR EVENT

START TIME OF ON-SITE MEDICAL COVERAGE

END TIME OF ON-SITE MEDICAL COVERAGE

ANTICIPATED ATTENDANCE OF EVENT

AMOUNT OF FINANCIAL SUPPORT YOU'RE ABLE TO PROVIDE

COMMENTS