General Information:

*Requesting Agency:

*Contact Person:

*E-mail Address :

*Contact Phone Number:

*Cancellation Number:

We need a number that our Communications Center can call in the event our crews are not able to attend.  A cell phone number is preferred.

Lecture Information:

*Date of Class:

*Location of Class:

*City/Town:

*County:

*Class Time (allow two hours):

Landing Zone information:

*Where will the helicopter land?

*Address/Crossroads:

*Location of landing area and what type of surface will they be landing on?

*Any Obstructions:

*Radio Frequency:

*PL Tone:

*Ground contact unit number:

*Please describe your request in detail and state if another air service will be in attendance: