Request Service

Please complete this form at least 2 weeks in advance of your event. The Primary Event Contact will receive confirmation of the request prior to the event start date.

Primary Event Contact

First Name

Last Name

Email Address

Phone Number

(###)

###

####

Event Name

Society / Organization

Event Date

YYYY

Event Location

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Event Start Time

Hour

Minute

Second

Event End Time

Hour

Minute

Second

Number of Participants

How many people are actively participating in the event? This will help us gauge the number of DMCRT teams required.

Number of Spectators

If applicable, how many spectators are you expecting?

Age Group of Attendees

i.e. Young children, university students, adults, older adults, all ages.

Event Details

i.e. Level of physical activity, indoors or outdoors, etc.

Will alcohol be served?

Yes

Will complimentary food or beverages be provided on site for our volunteers?

i.e. Coffee, lunch, meal vouchers etc.

Yes

No, but there will be food available for purchase on site.

Will a table and chairs be available for our volunteers and equipment?

Yes

Member Login

Welcome, (First Name)!

Enter Member Area

My Profile Log Out

Please complete this form at least 2 weeks in advance of your event. The Primary Event Contact will receive confirmation of the request prior to the event start date.

Dalhousie Medical Campus Response Team

6135 University Ave, Halifax, NS

B3H 4R2