When

Saturday, May 19, 2018 from 10:00 AM to 12:00 PM CDT
Add to Calendar

Where

West Des Moines Station #19

8055 Mills Civic Parkway
West Des Moines, IA 50266

Event Address Map
Driving Directions

Contact

Lisa Cota Arndt, Office Manager
IEMSA
515-225-8079
administration@iemsa.net

IEMSA EMS Memorial--Application for Name Placement

EMS MEMORIAL CELEBRATION We are accepting applications for the EMS Memorial Celebration to be held May 19, 2018 at the EMS Memorial located at WDM Station#19 on 8055 Mills Civic Parkway in West Des Moines, Iowa. The deadline is April 14, 2018.

* Required information

Deceased EMS Provider Information:

  • Line of Duty Death (No Fee) -- Individual was killed in the performance of his/her EMS duties.

  • National/State/Local Recognition ($125 Fee)--Iowa EMS Provider had a significant impact on National, State and Local EMS, spent at least 10 years providing EMS in Iowa, or died while an active member of a department.

  • Indicate the Type of Name Placement (see definitions above):

  •  characters remaining

Family Contact Information:

Sponsoring EMS Service Contact Information

  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • IEMSA Member?

  •  characters remaining
  • Fee

    Type Fee
    $125.00
    No Charge
$9,999.99

Payment

Payment Method

  • Please make check payable to:
    Iowa Emergency Medical Services Association
    5550 Wild Rose Lane Ste 400
    West Des Moines, IA 50266

Payment Summary


Register