Information Request Form:

Potential Volunteers, Medical Providers, Social Workers, and others interested in volunteer flying groups:  

Please print and complete this form to indicate your interest, receive information about public benefit flying groups, join newsletter mailing lists, and/or provide your comments.  This information will be circulated by ACA to groups appropriate to the items you checked.  Check all boxes and fill out all items that apply to you.

I am:  interested in volunteering as a pilot___;   right seat helper___; organizational helper___;  medical expert___; other (describe)___:

I/we need to obtain transportation for patients___;  transport blood/tissue/organs___; receive help with other charitable transport missions___ (describe here):

Please send me general information about:  ambulatory patient  transport groups (no medical staff needed enroute)___;  non-ambulatory transport groups (charitable air ambulance)___;  other medical flying groups___;   disaster and emergency relief groups___;  environmental flying groups___;  any other public benefit flying groups___.

I am only interested in groups serving:  Entire USA:___;     West:___;   Central___;   East___;    International___.

Please ask that I be added to any newsletter lists appropriate for the above items___.

I am a member of the media.  Please ask that I be added to groups' press release/media lists___.   Note that I represent the following publication/station/media group:

Please PRINT LEGIBLY:   Name:                                                           Title

Firm:                                                       Address:

City:                                                        State:                 ZIP:              Phone:                    

Email address:                                                                                            Fax:

Comments or other information:
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Return To:            Air Care Alliance
                              6202 South Lewis Avenue Suite F2
                              Tulsa, Oklahoma 74136-1064

NOTE:  This information will be circulated; however you are also advised to directly contact any groups in which you are interested if you do not hear back from them soon.  Please see the listings available at the Air Care Alliance web site:   www.aircareall.org


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