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2. To request on off-duty firefighter and/or EMS coverage for a public or special event, please review our policy and complete the following details:
4. What is your:
6. First Name
7. Last Name
9. Address1
11. Address2
13. City
14. State
15. Zip
17. Email address
19. Phone Number
21. How many firefighters/EMTs will you need?
22. What is the date of the event?
24. What are the hours of the event?
26. For how many hours will you need coverage and what are the hours? (For example: 4 hours, from 1:00 to 5:00 p.m.)
28. What is the name of the event?
30. What is the location/address of the event?
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field