Decrease (-) Restore Default Increase (+)
Print    Email
Bookmark and Share

LifeFlight Education & Training Request Form

LifeFlight Education & Training Request Form

LifeFlight Education & Training Request Form

Please submit this form to request a LifeFlight landing for a landing zone class or other public event.

* Indicates required information
Primary Date *  (mm/dd/yyyy)
Secondary Date  (mm/dd/yyyy)
Requestor's Name * 
Requestor's Title * 
Organization * 
Phone Number * 
Type of Event 
Event Details 
Number of Participants 
Landing Zone Coordinates 
North (3x.xx.xx format) 
West (7x.xx.xx format) 
Radio Frequencies (if applicable) 
Receive 
PL Tone 
Transmit 
PL Tone 
Landing Zone Description/Obstacles 
Authentication * 

If the challenge words are too difficult to read, click here to refresh.
 
© 2014 St. Mary's Health System   |  3700 Washington Avenue  |  Evansville, IN 47750  |  (812) 485-4000