Outreach Education

LifeFlight Observer Program Application

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

Phone Number (Cell Phone Preferred):

Email Address:

May we add you to LifeFlight's email list? Yes No

Preferred Base Site

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: