On Sunday, August 25th from 10:00 AM-5:00 PM, Dayton MMRS will be putting on a mass casualty exercise hosted by Kettering Health Network facilities. We are looking for people to serve as Controller/Evaluators in these exercises. If you are interested, please fill out your information in the survey below. Thank you.

*Where would you be able to serve as a Controller/Evaluator?
(Select all that apply)(Required.)

Soin Medical Center - Beavercreek

Greene Memorial Hospital - Xenia

No preference

*Controller/Evaluator Information
Last Name:(Required.)

*First Name:(Required.)

*E-Mail:(Required.)

*Confirm E-Mail:(Required.)

*Phone Number:(Required.)

*I would be comfortable serving as a controller/evaluator in the following areas:
(Select all that apply)(Required.)

Law Enforcement

EMS

RTF

ED

OR

Anesthesia

ICU/PACU

Blood Bank

Respiratory

HICS/Administration

Labs

Radiology/Imaging

Security

Environmental Services

Labor and Delivery

Victim Controllers

Simulation Cell