First Name *
Last Name *
Title *
Company *
Email *
Mobile Phone *
Department Website
Who is your employer/affiliation? * Hospital or Health System/DistrictPrivate Ambulance/EMSPaid Fire Dept/Rescue SquadVolunteer Fire Dept/Rescue SquadMunicipal EMS Agency/Third ServiceLaw Enforcement/PoliceIndustrial/CommercialMilitary/Federal & State GovernmentOther
Are you currently participating in selecting products or services for your department or organization? * YesNot currently but I will in the next 12-18 monthsNo
Which best describes your role for purchasing products or services? * I am the final decision makerI influence decisions that are madeI am not responsible for decisions
Give a brief description of your current product or service needs: *
Any colleagues who would be a good fit for the EMS Today MATCH program? (Please provide Colleague's name, title and email)
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Comments
EMS Today is part of Clarion Events, Inc. which is part of the Clarion Events Group of companies (Clarion).
We take your privacy seriously. We wish to use your information on the basis of our legitimate interests to keep in contact with you about relevant events, products and services which may be of interest to you.
We will only ever use the information we collect or receive about you in accordance with our Privacy Policy. If you prefer us not to contact you about relevant events, products and services that we believe you will be interested in, you can manage your preferences via a link we will send you, unsubscribe using the link in our emails or by emailing usprivacy@clarionevents.com.
*If I have provided a non-business domain email address (such as, but not limited to, gmail, hotmail, etc) I am doing so in the context of it being used for my business and not personal interactions with Clarion.