Get Moulage Request Form 710 - Miemss

Filling out the MOULAGE Request Form 710 is an essential step in requesting pediatric EMS educational resources in Maryland. This guide will provide you with clear and supportive instructions on how to complete the form accurately and efficiently online.

Follow the steps to successfully complete the MOULAGE Request Form 710

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. In the contact information section, provide the required details such as jurisdiction, agency, organization, or facility name, along with the contact person’s name and title.
3. Enter the mailing address, including city, state, and zip code, ensuring all information is accurate for communication purposes.
4. Include the phone number and fax number of the contact person, along with their email address for easy correspondence.
5. Describe your target audience in detail to help the state PEMAC Education subcommittee understand who will benefit from the requested resources.
6. Indicate the planned date of first use, as well as the estimated number of viewers who will access the educational resources.
7. Under future uses/audiences, provide insight into other potential applications of the requested resources.
8. Select the specific Pediatric Educational Resource you are requesting by checking the appropriate box next to ‘Realism Through MOULAGE CD’.
9. Sign the form and include the date of signature to validate your request.
10. Once all sections are completed, save your changes, and if necessary, download, print, or share the form for submission.

Ensure you complete your documents online for a smooth and efficient process.