AED Drone Delivery Program Interest Form

Full Name

First NameLast Name

Organization or Affiliation (if applicable)

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Delivery Address (Where would you like the AED delivered by drone?)

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Type of Location

Primary Reason for Interest in AED Drone Delivery

Have you previously used an AED or participated in a drone delivery program?

What is the estimated number of people present at your location on a typical day?

Are there any specific access challenges or restrictions for drone delivery at your location? (e.g., gated area, tall buildings, restricted airspace)

Preferred time window for AED drone delivery (if applicable)

How did you hear about the AED Drone Delivery Program?

Additional comments or questions