Medical Support Request Form

Could you use some help? Please fill out this Request for Medical Support Form for your event.In 2005, the Rescue Rider program was created to provide a "hands on" approach to help directly address the sobering statistics of rising motorcycle related deaths. Since that time, our Rescue Rider volunteers have logged thousands of miles supporting events like yours with our "Ride for a Reason" program.

Our volunteers provide emergency medical assistance to accident victims during The Golden Hour: In the world of emergency care, the "Golden Hour" is defined as the time period of about one hour in which the lives of a majority of critically injured trauma patients can be saved if definitive trauma care intervention is provided. This principle of rapid intervention can also be applied to non-trauma patients such as those having a heart attack or a stroke, in which time to treatment dramatically affects a patient's outcome.We are currently filling in our "Ride for a Reason" support calendar if you would be interested in having our volunteer Rescue Rider "First Responders" support your event this year please fill out this form and our Officers will be in contact with you.

For assistance with this form, please contact the website administrator.Thank you!

Event Name

Event Date

Start Time

End Time

Start Location

End Location

Beneficiaty of Event

Event Contact

Contact Phone#

Contact Email


Anticipated Attendance

Last Years Attendance

Is Beneficiaty a 5O1C3 Charitable Organization?

Is event open to all riders regardless of race, religion, affiliation?

Will there be any events planning meeting that we may attend?:
Dates, Location, Time:

Enter what you see in the image in the box below using only lowercase A - Z & the numbers 2 - 9