CEMTP Outreach Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form is to make requests for CEMTP to be a part of a community outreach event.

Here is our event/activity participant agreement:

https://docs.google.com/document/d/1YkI0ARqogqaXavassPjMN4xTTWBbGuDZePwtpvsk1DA/edit?usp=sharing

We reserve the right to decline any request.

All questions should be directed to Liz Coykendall, Board Member for Cary Area EMS (doing business as Community Emergency Medical Training and Preparedness) via email at lcoykendall@caryems.com.

Email *

Prior to submitting your outreach request form you need to acknowledge the participant terms that are linked above. *

I agree to the participant terms.

Clear form

Never submit passwords through Google Forms.

This form was created inside of Cary EMS. Report Abuse

Forms