Search this site:
Mdewakanton LIFE Program
Learn more about our AED Program and how to request an AED for your organization.
read more ►
Home
Emergency Services
About
Explorer Program
Equipment
Staff
Newsroom
Education
Services
Event Calendar
Photo Galleries
Job Opportunities
Mobile Unit
About
Medical Clinic
Incident Command Center
Photo Galleries
Mobile Event Request
Virtual Tour
Contact Us
Map / Location
Contact Form
Request a Tour
Feedback
Mdewakanton Emergency Services Trains with Prior Lake Fire on House Burn
read more ►
LP Propane Training at Prior Lake Fire
read more ►
Jordan SCALE Burn Facility Training
read more ►
-
A
+
A
Home
› AED Request Form
AED Request Form
Organization Information
Organization:
*
Organization Contact:
*
Medical Director:
Phone Number:
*
Format: xxx-xxx-xxxx
E-mail Address:
*
Organization Address:
*
City:
*
State:
*
- Select -
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip:
*
About the Organization:
*
How will the AED be utilized?:
*
Area and population your organization covers:
*
Number of AEDs requested:
*
Word verification:
*
(
verify using audio
)
Type the characters you see in the picture above; if you can't read them, submit the form and a new image will be generated. Not case sensitive.