18E 2023 Soin Medical Center and Greene Memorial Hospital FSE Victim Actor Sign-Ups

On Sunday, April 30th 10:15AM-4:00 PM, Dayton MMRS will put on a mass casualty (MCI) exercise hosted by Soin Medical Center and Greene Memorial Hospital. We need volunteers to portray victims in this exercise. If you are willing to roleplay, please fill out your information in the survey below. Thank you.

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* Actor Information
Last Name:

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* First Name:

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* Age Range

5-11 (must be accompanied by an adult and must understand that the exercise involves simulated gunfire and realistic-looking moulaged injuries)

12-17 (must have parental permission)

18 and over

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* E-Mail:

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* Confirm E-Mail (Very Important: you will receive all information about the exercise via email.):

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* Cell Phone Number:

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* Where would you be able to serve as a victim or other actor?
(Select all that apply)

Soin Medical Center - Beavercreek

Greene Memorial Hospital - Xenia

No preference

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* Actor InformationLast Name:

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* First Name:

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* Age Range

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* E-Mail:

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* Confirm E-Mail (Very Important: you will receive all information about the exercise via email.):

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* Cell Phone Number:

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* Where would you be able to serve as a victim or other actor?(Select all that apply)

* Actor Information
Last Name:

* Where would you be able to serve as a victim or other actor?
(Select all that apply)