Request EMS at a Special Event

JavaScript Required

You must have JavaScript enabled to use this form. Please enable JavaScript and reload the page. If you cannot enable JavaScript, please contact webadmin@cityofmadison.com to provide your information.

Event Information

Event Name * required

Date * required

Start Time * required

Expected Duration * required

Location

Location Name

Street Address * required

Unit

City * required

State * required

ZIP Code * required

Estimated number of participants * required

Map * required

One file only. 10 MB limit. Allowed types: gif jpg png bmp heic heif eps tif psd odf pdf doc docx ppt pptx.

Emergency Action Plan * required

One file only. 10 MB limit. Allowed types: gif jpg png bmp heic heif eps tif psd odf pdf doc docx ppt pptx.

Additional Information

Personnel & Equipment

Event radios provided? * required

Yes

No

What channel will be used?

Teams Needed * required

Paramedics

Ambulance

EMS Walking Team

UTV Ambulance

Paramedics

Number needed

Staging location

Expectation of duties

Report time

Ambulance

Number needed

Staging location

Expectation of duties

Report time

EMS Walking Team

Number needed

Staging Location

Expectation of duties

Report time

UTV Ambulance

Number needed

Staging Location

Expectation of duties

Report time

Staff Briefing

Briefing Time * required

Location * required

Event Coordinator

Name * required

Phone * required

Alternative Phone

Email * required

EMS Coordinator

Name * required

Phone * required

Alternative Phone

Email * required

Other Contact Information

Name

Phone

Alternative Phone

Email

Billing Information

Organization * required

Name * required

Phone * required

Email * required

Street Address * required

Unit

City * required

State * required

ZIP Code * required

Request EMS at a Special Event

City of Madison Fire Department

Join MFD

Services

Connect with us

Our Madison – Inclusive, Innovative, & Thriving