Mdewakanton Emergency Services

SERVICES

Organization Information

Organization*
Organization Contact*
Medical Director
Phone Number*
Email Address
Organization Address*
City*
State*	Zip*

About the Organization*
How will the AED be utilized?*
Area and population your organization covers*
*required information

Submitted forms will be followed-up by a phone call within 30 days of receiving the request. If you have any questions, please contact the AED Coordinator at:
Mdewakanton Emergency Services c/o: Mdewakanton “LIFE” Program 2330 Sioux Trail NW Prior Lake, Mn 55372