Request for Moulage Artists

North Central Texas Council of Governments

Your name

Your Cell Phone

Phone

Your Email

Organization Name

Event Name

Event Type

(MCI, Active Shooter, Disaster, CERT Drill, etc.)

Event Date

Event Location

Include address, room location for moulage, and parking info

Start Time for Moulage Artists

End Time for Moulage Artists

Number of Moulage Artist Needed

Number of Actors needing Moulage

Type of Wounds

Gun shot wounds, burns, lacerations, fractures, impalement, etc.

Are Moulage Supplies Provided by Entity?

NCTCOG supplies are available upon request, but limited

Can artist bring additional supplies

Event Point of Contact Name

Event Point of Contact Email

Event Point of Contact Phone

Phone

Are there any security issues?

Send me a copy of my responses