Support LifeFlight Education and Patient Programs
Applicants must be 18 years of age or older, shorter than 6' 3" and weigh no more than 200 lbs.
First Name: Last Name:
Are you at least 18 years old? Yes No
Height: Weight:
Service, Department or Hospital Affiliation:
Certification (check one):
First Responder EMT EMT-P RN MD Fire Fighter Police Officer Other
First Responder EMT EMT-P RN MD
Fire Fighter Police Officer Other
Phone Number (Cell Phone Preferred):
Email Address:
May we add you to LifeFlight's email list? Yes No
Preferred Base Site Boquet Airport (Jeanette) Butler Airport Canonsburg Hospital Indiana Hospital Rostraver Airport
Briefly explain what you hope to gain from your experience with LifeFlight?
Provide 3 dates that are good for you. Please assure that the dates you submit as available will not change as it is very difficult to reschedule them. (The extern program is available every day between the hours of 9 a.m. and 5 p.m.):
Do you have any significant medical condition(s) that might interfere with your ability to fly with us? Yes No
If "Yes", please explain:
