Disaster Exercise Volunteer Form

Date: May 5th, 2018
Times: 7:00am - 12:00PM
Location: Midland International Air & Space Port
Statement of Purpose: The Federal Aviation Regulation (FAR) Part 139.325 requires that the Midland International Air & Space Port conduct a full-scale emergency exercise at least once every three (3) years. This exercise is designed to test the response times and performances of area law enforcement, firefighting agencies, emergency medical personnel and other interested community organizations that would be involved in an actual airport emergency.
In order to simulate an actual emergency, volunteers are required to play the roles of victims and family members. The exercise will require that some volunteers are assessed and transported to area medical facilities, family reunification locations, and the terminal building. The exercise will be completed when all volunteers have returned to the airport. Lunch will be provided to volunteers and emergency personnel. A raffle for door prizes will also be conducted at the conclusion of the exercise.
Thank You!

* 1. Your Contact Information

* 2. Emergency Contact Information

* 3. Have you ever participated in an airport disaster drill before?

* 4. Please select an age range.

* 5. Desired Role. Please rank from 1 to 4 (1 being the most desired to 4 being the least desired).

  Most (1) (2) (3) Least (4)
Victim (a passenger or
crew member aboard
the aircraft)
Family Member (will be
acting as family
members of the victims)
(answering questions
and help with exercise
administration tasks)
Drill Assistance (helping
with parking, food
service, etc.)

* 6. Do you have any Physical Limitations or Health Issues we should be aware of?

The drill will require you to be out in the elements and weather that day. Additionally fake blood, makeup, and fake injuries are
used to provide realism. We suggest if you want to be a victim you wear older clothing that you don't mind if it is stained,
dis-colored, or damaged.

The drill will take place on May 5th, 2018. The drill requires a time commitment from 7:00AM to approximately 12:00PM.

* 7. Do you need confirmation of your participation for Community Service hours?