Event Medical Cover Quote Form.

Event Medical Cover Quote Form

Please complete the below information. On completion we shall complete a risk assesment of your event based on the information provided in this form and send you a no obligation quote.

Should you leave this form without submitting you may return to it within 24 hours and it will save your entered data.
Company Name
If Applicable
Full Name*

First NameLast Name
E-mail*
Contact Number*
Invoice Address*

Street Address

Street Address Line 2

CityCounty

Postal Code

Event Information
Event Name*
Is the event address the same as the invoice address?*

YesNo
Event Address*

Street Address

Street Address Line 2

CityCounty

Postal Code
Is the contact details for the person at the event the same as the details entered on the 1st page?

YesNo
Main Contact Name*

First NameLast Name
Main Contact Number*
Available To Call At Event

Event Details
Description Of Event*
Website For Further Event Details
Expected Numbers*
On Site At Any One Time, This should also include expected spectator numbers.
How Will They Be Accommodated*
Audience Profile*
Past Event History*

Declaration

By signing this form, I understand that I am requesting a quotation for the services of Rapid Response Medical Group. I acknowledge that completion of this form does not constitute a firm booking, I have completed this form with correct information to the best of my knowledge and will undertake to inform Rapid Response Medical Group of any changes to the information.

I will forward all relevant documentation to Rapid Response Medical Group including Risk Assessments, Site Plans and Emergency Escalation Plans to info@rapidresponsegroup.co.uk before confirmation of booking.
Please rate how you have found this experience
Where did you hear about us?*
Electronic Signature*
Date

DayMonthYear
Should be Empty: