Contact / Invoice Information:

Organisation
Name
Street Address
Address (cont.)
City
County
Post Code
Home Phone
FAX
E-mail

How do you wish to pay?     Cheque on Day               Cash on Day          Invoice             Credit Card (PayPal)*  

*3.5% processing fee     

Contact on Day

Contact number

Event Details

Name of Event

Type of Event

Please select Agricultrial Show/County Show (2) Classical Concert (2) State Occasion (2) Marine Event (3) sports event (3) Public Exhibition (3) Motorcycle Display (3) Avation (3) Music Festival (3) Family Fun Day (3) VIP Visit/Summit (3) Motor Sport - Racing (4) Bonfire/Fireworks/Pyrotechnics (4) Pop/Rock event (5) Possible medium public disorder (5) New Year Celebration (7) Possible Hige level of pubic disorder (7) Dance Event (8) Public Demonstration - Opposing Sides (9)

Time of year         Summer / Winter       Spring / Autumn

 Are there any additional Side Events? (e.g. Carnival, Helicopters, Motor Sport, Parachute Display, Street Theatre etc) Please list all

Venue Details

Address of Venue/Event

Street Address
Address (cont.)
City
County

Post Code (if Known)

Type of Venue         Please SelectIndoors (1)Outdoors but small area (2) Stadium (2) Outdoors - Wide Area (3) Widespread Public Locatin - Town centre/streets (4) Tents/Marquees (4) Overnight Camping (5)                       Number of Sites       

Date (s) of event         to        

Start Time            Finish Time           

If times are different for additional days, please put times and days in the 'relevant information' box at the end of the form

(We aim to arrive 30 mins before the start to set up where required.)

Audience Details

Will the audience be   Please select Seated All the time (1) Standing most of time (3) Seated and Standing (2)      Type of audience you are expecting? Please select Wide range of ages in Family groups (2) Wide range not family (3) Young Adults - 18-24 (3) Mostly Children or Elderly (4) Wide Range Rival Groups (5)      

Number of People expected        Please select Up to 1000 (1) Up to 3000 (2) Up to 5000 (8) Up to 10,000 (12) Up to 20,000 (16) Up to 30,000 (20) Up to 40,000 (24) Up to 60,000 (28) Up to 80,000 (34) Up to 100,000 (42) Up to 200,000 (50) Up to 300,000 (58)          How long will they be queuing?        Please select Less then 4 Hours (1) More than 4 Hours (2) More than 12 Hours (3)

Number of casualties at last event         Please select Less than 1% (-1) Medium Rate 1-2% (1) High Rate over 2% (3)     

General Details of Event

Have we covered this event before?       Yes No

How close is the nearest A&E?       Please Select Less than 30 mins by road (0) MOre than 30 mins by road (2)                          Is the A&E       Please select Small (3) Large (2)

What accommodation is available for medical treatment?

Are there any safety or club rules to comply with? (e.g. Dress code etc) please give details

Is there Electricity available in the treatment area/for our medical unit?

Yes
No

Are there toilets on site?

Yes
No

Does your public liability insurance stipulate medical cover?

Yes
No

Will there be a doctor on site?

Yes     How can we contact them?
No

Will you provide staff with refreshments?

Yes
No

Any other relevant information you feel we should consider or know

I have read and agree to the standard terms and conditions click here

  Yes
  No