If FDIC were to obtain a monitor/defibrillator for use during the competition, please select the monitor brand and model that you prefer below (note that Physio-Control LifePak 12 and Phillips mRX monitors may be used, but can't be obtained by FDIC).* Zoll X-SeriesPhysio Control LifePak 15Other
If other, please specify:
Team Leader First Name
Team Leader Last Name
Team Leader Certification ALSBLS
Team Leader Title
Team Leader Organization
Team Leader Cell Phone
Team Leader Email
Team Member #1 First Name
Team Member #1 Last Name
Team Member #1 Certification ALSBLS
Team Member #1 Title
Team Member #1 Organization
Team Member #1 Cell Phone
Team Member #1 Email
Team Member #2 First Name
Team Member #2 Last Name
Team Member #2 Certification ALSBLS
Team Member #2 Organization
Team Member #2 Title
Team Member #2 Cell Phone
Team Member #2 Email
Team Member #3 First Name
Team Member #3 Last Name
Team Member #3 Certification ALSBLS
Team Member #3 Title
Team Member #3 Organization
Team Member #3 Cell Phone
Team Member #3 Email
Alternative Team Member First Name
Alternative Team Member Last Name
Alternative Team Member Certification ALSBLS
Alternative Team Member Title
Alternative Team Member Organization
Alternative Team Member Cell Phone
Alternative Team Member Email
Has your department ever competed in the JEMS Games before? YesNo
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