Huntingdon County EMA Knowledge Base

EMA Assistance

Please fill out the following form and let us know what we can do to help you during a rescue assistance! If your disability is not listed, please describe how we can help you out in the comments field below.

General Information:

First Name:
Last Name:
Email Address:
Phone Number:
Birth Year:

Location:

Affiliated Region:
Street Address:
PO Box:
City:
State Abbreviation:
Zip:

Disability/Additional Info:

Disability:
Additional Comments (anything else we should be aware of):
For security purposes, please fill out the word in the picture below (if you are unable to identify the text, please contact the EMA office for assistance):

Copyright Juniata College FTP Club, 2006