Life Flight LZ Class request form

Life Flight LZ Class request form

Contact Name*

Date request made*

Please enter date request is submitted, NOT date of event

Type of Request?*

Select

If you selected other, please indicate type here

If you entered "other" please indicate type here

Brief description of event request*

Email address*

Cell Number*

Address for classroom portion*

Address/GPS coordinates for LANDING ZONE*

Requested date of class*

Requested time of class*

Please enter numeric value using 24 hour clock

Secondary date for event*

Projected number of students*

Please enter numeric value

Is there a projector and/or AV system available?*

Select

Radio frequency for LZ command*

Select

If you selected other radio freq. indicate here

If you selected other, please indicate radio freq. here

Brief LZ description (size, surface, hazards)

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