5th Annual

Gi vi ng Back t o EMS
Ap plica tion
Eligibility Requirements:
Application and essay must be postmarked or emailed by December 12th, 2014
Applicants must be a member of the MAA and a Minnesota EMS or Medical Response
agency/unit


Process:
Applications and essays are reviewed by the Giving Back to EMS Committee
The committee will select the Giving Back to EMS winner and notify the winner late
December
The donation will occur at the Arrowhead Conference in January. www.arrowheadems.com/
conference













ESSAY REQUIREMENTS:
Please provide a written
snapshot of your EMS
service (members, area
served, calls per year,
unique facts)

Describe why your EMS service
should be awarded this Giving
back to EMS vehicle

Agency Name________________________________________________________________

Mailing Address______________________________________________________________

Contact____________________________________________Phone #__________________

Email_______________________________________________________________________
DEADLINE: December 12, 2014
Please forward application and essay to:
Debbie Gillquist
1612 Summit Hill
Eagan, MN 55122
Questions? 651-775-7400
debgillquist@mnems.org