Observer Application

Working closely with those who call Life Star of Kansas is part of maintaining safety when working around the helicopter.

Life Star of Kansas is now inviting those areas/agencies that utilize Life Star an oportunity to come and spend the day.

A Life Star of Kansas Flight Observer must currently be active with a health care agency, emergency services provider and Certified as one of the following: EMT, Paramedic, Fire/Rescue Personnel, Communications Specialist, CRNA, RN, LPN, a Physician or currently a student in these areas.

The Observer must be:

* In good physical health, no history of motion sickness and cannot be pregnant.

* Must be 18 years of age

* Not weigh over 210 lbs

Personal Information

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Weight: *

Age: *

Emergency Contact

Name *

Relationship *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Agency Affiliation

Job Title / Position *

Affiliation *

Training *

Agency *

Street Address *

Address Line 2

City *

State *

Zip Code *

Work Phone: *

Fax: *

Base location preference? *

No Preference	Lawrence
Junction City

Additional Information

Anything additional you wish to add?