The EMS Safety Foundation


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Registration of Interest to Participate in the Innovation Consortium



If you would like to Register your interest to participate in the Innovation Consortium of the EMS Safety Foundation, please complete this form. We look forward to hearing from you, and to the opportunity to have you participate in this new forum for enhancing the safety of EMS and developing new ideas and practice innovation.

 
Name:

Company:

Location:

No. of Ambulances:

No. of Annual Runs:

Type of Service (volunteer, private, municipal):

Phone:

E-Mail:

Please Confirm E-Mail:


Would you like to be placed on an email list to be notified of developments and new initiatives?


Please note: Your information and details will not be used for any other purpose and will not be shared with any other organizations.


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