Register Your AED

Welcome to the Tri-County EMS/CMHVI AED Project site. If you have an AED and would like to participate in our project and be listed on our site please fill out the registration form.

If you need any help with this form please call Tri-County EMS at 207-795-2880.

Before you complete the application view our FAQ page.

*required fields

ORGANIZATION CONTACT INFORMATION

Organization Name:*
Contact First Name:*
Contact Last Name:*
Mailing Address:*
 
City:*
State:
Zip:*
Email:* This will be your login username.
Choose a Password:*
Confirm Password:*
Phone:* (xxx-xxx-xxxx)
Do you have personnel trained in CPR/AED? Yes       No
If yes, how many trained personnel?


FACILITY INFORMATION

Please enter information for the facility where your AED(s) will be located. If you have more than one facility you can add additional facilities after completing this form.

Facility Name:*
Street Address of Facility:*
 
City:*
State: Maine
Zip:*
Do you have personnel trained in CPR/AED at this facility? Yes       No
If yes, how many trained personnel?
Specific location of AED(s) at this facility:

Please enter specific locations / rooms (i.e. 'recreation room') within the facility entered above for the AEDs you are requesting as well as for those you already have.

NOTE: If you have or are requesting AEDs at another facility other than the address entered above, you can enter those on the following page.





SPECIFIC LOCATION 1:

If you don't have all the information for an AED you can leave those fields blank and enter it at a later date.

Location / Room:
Brand:
Year Manufactured:
Serial Number:
add another location/room at this facility

 
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