Please complete the form below in its entirety and click submit when finished. You will receive a response in the next 48 hours. Thank you! Please be advised the fee for a dedicated Upstaff is $200.00 an hour, for a minimum of four hours. Special Event Coverage Request Name* First Last Email* Phone*Event Name* Event Location* Event Address* Street Address City ZIP / Postal Code Event Date* MM slash DD slash YYYY Start Time : Hours Minutes AM PM End Time : Hours Minutes AM PM Please select the following*AmbulanceCPRUBike TeamNumber of Paramedics?*12Please indicate if you are requesting voluntary or paid attendance*Voluntary AttendancePaid AttendancePlease provide any further details or instructionsPhoneThis field is for validation purposes and should be left unchanged.