OSF Life Flight PR Request Form - Peru

Please fill out the request form below with as much detail as possible about your needs.

* indicates a required field.

Please enter the following information

Requesting Department/Agency: *

Aircraft Requested: *

Date of Event: *

Start Time: *

Aircraft Arrival Time:

Type of Event: *
LZ/Helicopter safety class, Mock Scene, Static Display, Administrative, Other

Prospective Audience: *

Expected Attendance: *

Name of Event Organizer: *

Contact Email: *

Contact Phone Number: *

Emergency Contact Number Day of Event: *
(weather or patient flight may cause cancellation)

Address of Event: *

Audio/Visual Needs: *

Latitude N:

Longitude W:

Type of Surface:

Obstacles:

Landing Zone Location:

Landing Zone Personnel:

Landing Zone Size:

Radio Frequency:
(IREACH is preferred)

PL Tone:

Call Sign:

Comments / LZ Info:

Departments Invited:

For more information, please contact OSF Life Flight Outreach Coordinator: Jennifer.R.Wilkes@osfhealthcare.org.

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