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FORM: REQUEST FOR
SUPPORT BY CITRO To better
understand you request and what you'd like CITRO to do for you, please
fill out this form. We will then be able to evaluate your request. CITRO can not
guarantee support to your event, as CITRO is available 24 hours 7 days a
week for Emergency Response /Maritime Search And Rescue. |
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YOUR ORGANIZATION
(name) |
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ADDRESS (line 1) |
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ADDRESS (line 2) |
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ADDRESS (line 3) |
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PHONE - MOBILE |
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PHONE - LANDLINE |
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EMAIL - GENERAL |
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EMAIL - SPECIFIC |
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FAX |
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REQUEST BY (name) |
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REQUESTED ON (date) |
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CONTACT PERSON
(name) |
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TYPE OF EVENT |
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LOCATION OF EVENT |
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EVENT NAME |
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EVENT DATE |
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EVENT TIME FOR
CITRO TO BE ON-SCENE |
from
untill
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EST NR OF
PARTICIPANTS (lives directly at risk) |
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EST NR OF STAFF IN
EVENT (live indirectly at risk) |
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WHAT IS THE PURPOSE
OF YOUR EVENT |
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REQUEST FOR SUPPORT
(brief description) |
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OFFICIAL REQUEST
FOR PERMIT
FILED? (yes/no) |
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OFFICIAL PERMIT
GRANTED? (yes/no) |
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POLICE ON-SCENE
(yes/no) |
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CEMS ON-SCENE
(yes/no) |
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RODE KRUIS ON-SCENE
(yes/no) |
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MEDICS ON-SCENE
(yes/no) |
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PARA MEDICS
ON-SCENE (yes/no) |
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Before you submit
please do read & check the boxes one by one |
CITRO is a Non-Profit
Organization |
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CITRO works with Volunteers
only |
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CITRO has no paid staff |
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CITRO will abandon scene
for 'no-play' SAR Missions |
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CITRO kindly requests
availability of non-alcoholic F&B |
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CITRO welcomes your
donation to the foundation |
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CITRO fuel charges will apply
based on hourly rate |
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