Event/Landing Zone Safety Education Request

Please complete all information below and submit the form to initiate the request.
PLEASE NOTE: You will be contacted via e-mail within 5 business days to discuss your event. All requests must be submitted at least one week in advance of the requested date. 

All fields are required.

General Information

 
 
Type of Request:
Requesting Agency:
Contact Person:
E-mail Address: 
Contact Phone Number:
(Please include area code.)

 Type:  
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.


Event/Class Information

 
Date: 
If this is an event, please indicate the type of event:
If this is a class, please indicate the location of the class:
City/Town:
County:
What time would you like the
Helicopter/Mobile ICU to arrive?
For class, indicate class time:
(Please allow 2 hours.)
(This could be a specific time or a time frame, depending on the event type.)


Landing Zone Information

 
 
Where will the helicopter land?
Address/Crossroads:
Location and Type of Surface of Landing Area:
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:  
 

 

Quick Reference

AirCare
Request Transport

AirCare Dispatch
800-336-6224

Administrative Contacts

Phone 336-713-3110
Fax 336-713-3135

Program Manager
hmason@wakehealth.edu
Outreach Coordinator
araymond@wakehealth.edu

Find A Doctor Ways to Give
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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.