Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

EMS Public Relations Request

  1. CCEMS Logo - Est 2009 - PNG small

  2. EMS Public Relations Request

    Cole County Emergency Medical Services is honored you are interested in having us participate in your event. If you would like to have our EMS professionals attend and bring an ambulance, please fill out the form in its entirety. Incomplete form may result in your request not being fulfilled.

    Please note if you require an ambulance to be on standby, meaning that the EMS unit cannot be in-service to handle emergency assignments, there is an hourly charge for a dedicated EMS crew. Please use the standby request form if you require a dedicated EMS unit.

  3. Event Contact Information

  4. I understand that if a EMS unit is able to attend, they are in-service and will be available for an emergency assignment, which means they may leave a a moments notice.*

  5. Leave This Blank:

  6. This field is not part of the form submission.