Outreach

Outreach Request

To schedule a Life Flight Outreach event, please fill out this form, If you have any questions, please feel free to call Outreach at (503) 678-4364, ext. 109. Please allow two business days to process.

Date of Event *:	if your event is within the next two business days, please call LFN at (503) 678-4364
Time of Event *:	to
Address of Event *:
State of event *
Name of Organization *:
Type of Event *:	Other :
Event Coordinator Name *:
Event Coordinator Cell Phone *:
Event Coordinator Email Address *:
Additional Event Information or Comments:
Expected number of attendants:
Does this event require a helicopter?
Requested arrival time of the helicopter:
GPS Coordinates (not required):
Landing Zone Description:
Landing Zone Address & Cross Street:
Fire Department Name:
Landing Zone Officer Name:
Landing Zone Officer Cell Phone #:
Air to Ground Radio Frequency & Frequency Name:
DO NOT FILL IN BELOW - WILL BE COMPLETED BY LIFE FLIGHT ADMIN
Scheduled By:
Approved By:
Base Assigned to:
Faxed to Base:
Flight Number:
Completed:
Reason if not completed: