INSTRUCTIONS - Please read carefully: this form is the fastest way to get your request to all the groups which may be able to help you.
Choose one of the following options to obtain a list of volunteer pilot groups serving your area or your flight route. Then continue filling out the form that appears below. NOTE: When you submit the completed form a list of groups will appear. We suggest you print out and save the list for further reference. You may Use the CONTACT THIS GROUP to send your form information to one or more groups. Your information will then be sent to any groups you selected so they can contact you about your inquiry. Do not include any information you wish to remain private:
* indicates that field is required
Patients & Medical Transport: Choose if you are a patient, family member, social worker, hospital staff member, or other person needing some type of patient or medical transportation. Other Missions: Choose if you need the services of groups flying disaster and emergency relief missions, environmental support flights, animal transport, educational flights, or other missions of community service using aviation. Pilots & Volunteers: Choose if you are a pilot or other person interested in volunteering for one or more groups serving your area. This is for pilots, medical personnel, amateur radio operators, emergency service workers, airport business owners, helpers, and other contributors. General Info: Choose if you seek general information about all groups serving your own state. This is for anyone interested in charitable flying, including members of the media. If you seek information about groups serving another state, indicate that state here. Other: Choose if you seek information for any other reason.
What type of transportation best describes your needs:
Disaster & Emergency relief
Environmental support
Ambulatory patient - able to sit in an airplane seat and not require professional medical care while flying
Non-ambulatory patient - needs to travel on a stretcher or have professional medical care while flying
Blood, tissue, organs, personnel, or other medical missions not involving patient transport
Does the patient require a stretcher onboard?
Yes No
Is inflight medical attention required?
Is the patient traveling for cancer treatment?
Will the patient be younger than 18 years of age at the time of travel?
Requesting assistance for myself
Requesting assistance for someone else
My role or relationship to the patient is:
Patient's First Name and Initial only for Last Name:
Country*
State*
City
Postal code Phone Fax Email*
Patient/Medical Transport
Emergency Service, Disaster Relief and other Community missions
Animal Transportation
Youth Education
PBF Organization Support
I am:
An active pilot
A student pilot
Non-pilot
Press or media
Health care agency or service organization
Non-profit organization
Other
Departing From:
Traveling to:
City Going One Way Round-Trip
Proposed or possible dates
Provide a complete description of the patient's or your need* characters remaining remaining
Area of coverage location:
Proposed departure point
Purpose/Objective of the Flight* characters remaining remaining
I was referred to The Air Care Alliance by:
If other, please specify:
Please add me to your mailing list: Yes No
We will not share your email address without your consent; please refer to our privacy policy for details.
