Boston University Fitness & Recreation Center

Coverage Request

Requests must be submitted one week prior to event to guarantee EMS coverage. Confirmation of event can be expected within 3 business days of the form being submitted.

* denotes required field

Client Information

Contact Name: *

Affiliation:

Department / Organization Name:

BUID:

E-mail: *

Phone Number: *

Fax Number:

Mailing Address: *

City: *

State: *

Zip: *

Event Information

Event Name: *

Event Description:

Number of EMTs requested: *

Event Location: *

Date and Time Information

Day One:	,
	Start Time*	:
	End Time*	:
	Person EMT(s) Should Report to On-Site (Day One): *
Day Two:	,
	Start Time	:
	End Time	:
	Person EMT(s) Should Report to On-Site (Day Two):
Day Three:	,
	Start Time	:
	End Time	:
	Person EMT(s) Should Report to On-Site (Day Three):

Miscellaneous

Expected Number of Participants: *

Age of Participants:

(Expected) Number of Spectators:

Advisor Name:

Advisor Phone:

Advisor Position:

Notes:

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By clicking submit you understand that it is your responsibility to notify BUEMS in writing (buems@bu.edu) within 48 hours of any changes to time, date, location, or number of participants. If your event is cancelled or changed and there is no notification you will be charged the full amount of your previous request.

Any changes or requests made within 24 hours are not guaranteed to have coverage. Please e-mail buems@bu.edu with any questions, comments, or concerns.