SPECIAL EVENTS COVERAGE REQUEST FORM

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SPECIAL EVENTS COVERAGE REQUEST FORM

(Use this form to request coverage for your campus event from Public Safety and/or VEMS)

Section One - Contact Information

Name:
Department:
Account Number:
Local Address:
Phone Number:
Email:

Section Two - Event Information
Event Name:
Date of Event:
Time of Event:	From: To:
Type of Event:
Location of Event:

Sponsor of Event:		Contact Person:
		Contact Number:

Promoter (if any):	Contact Person:
	Contact Number:

Performers:	Admission Charge:

What type of staff
are you requesting?    Public Safety Officer(s)
                                 Radnor Police Officer(s)
                                 Ambulance and Crew with EMT level training
                                 Ambulance and Crew with Paramedic level training

Will additional parking be needed? YES NO
If so, how many spaces
do you expect to need?

Is this the first time
this event is being held? YES NO

How many people
are expected to attend?        1-50
                                            51-100
                                            101-500
                                            More than 500
                                            Unknown

What type of event
is this?                                    Athletic Competition
                                              Lecture/Movie
                                              Concert
                                              Greek Life Affiliated
                                              Other - Specify Below

Please give a brief event description and any additional information (including starting and ending times). A representative from the Department will contact you shortly.

(You will receive a confirmation page upon successful submission of this form)

All entries are required, and improper submissions will not be processed.