EMERGENCY MEDICAL SERVICES / PUBLIC SAFETY SIX MILE CYPRESS PARKWAY FORT MYERS, FL 33912 (239) 533-3911 the appropriate box(es) below: SPECIAL PERMIT USE OF COUNTY PROPERTY PERMIT FILM PERMIT AFTER REVIEWING THE APPLICATION, PLEASE INDICATE BELOW WHAT ARRANGEMENTS YOUR ORGANIZATION WILL REQUIRE THE APPLICANT TO COMPLY WITH FOR THEIR EVENT. Treatment Facilities: Medical Personnel: Medical Supplies / Equipment: Safety Requirements: Fee for Services Special Arrangements: Print Name: Signature: Title: Date:
EMERGENCY MEDICAL SERVICES / PUBLIC SAFETY SIX MILE CYPRESS PARKWAY FORT MYERS, FL 33912 (239) 533-3911 the appropriate box(es) below: SPECIAL PERMIT USE OF COUNTY PROPERTY PERMIT FILM PERMIT AFTER REVIEWING THE APPLICATION, PLEASE INDICATE BELOW WHAT ARRANGEMENTS YOUR ORGANIZATION WILL REQUIRE THE APPLICANT TO COMPLY WITH FOR THEIR EVENT. Treatment Facilities: Medical Personnel: Medical Supplies / Equipment: Safety Requirements: Fee for Services Special Arrangements: Print Name: Signature: Title: Date: