MIH-CP Agency Contact Form

NAEMT can help EMS agencies undertaking MIH-CP with the latest news, reports, data, and studies on the subject. We can also help you connect to the largest pool of MIH-CP experts in the nation. If your EMS agency is currently operating or developing an MIH or CP program, please provide your contact information below:

*By providing a telephone number and submitting the form, you are consenting to be contacted by SMS text message. Message frequency may vary. Message & data rates may apply. To end messaging from us, reply with STOP. Reply with HELP for more information.

First Name *

Last Name *

Organization *

Mailing Address 1 *

Mailing Address 2

City *

State *

Zip *

Phone *

Email Address *

Please tell us about your agency.*

My agency currently has an MIH or CP program.
My agency is developing an MIH or CP program.
My agency does not have an MIH or CP program.

Do you wish to be added to NAEMT's MIH-CP list serve? *

Yes, I want to receive emails about MIH-CP.
No, I am not interested in receiving emails about MIH-CP.

Generate New Image

Type the code from the image