To register your AED with local emergency service agencies, please fill out the following form. Move from one box to another by using the tab key or clicking in each box. (Pressing the enter or return key may cause a partially completed form to be submitted.)

Name:

Enter the name of the organization or individual that owns the AED.

AED Prescribing Physician's Contact Information:

Please enter the name of the physician who prescribed the AED, if any.

Physician's Name
Street or Box Number
City
State
Zip Code
Telephone Number ( )- ext. (if no extension, leave blank)

AED Coordinator/Owner's Contact Information:

AED Coordinator's Name
Street or Box Number
City
State
Zip Code
Telephone Number ( )- ext. (if no extension, leave blank)
E-mail Address  

AED Equipment Information:

Date AED was installed (MM/DD/YY)
AED Manufacturer:
AED Model Number:
AED Serial Number:

Where is the AED Located?

*Please note: Local EMS agencies will be notified of your AED registration based on the address information entered below. Please be sure and put the address where the AED is physically located rather than your corporate headquarters or other address.

Street Address
City
State
Zip Code
Where is the AED located at the address? Be as specific as possible.
 

What is your CPR/AED training status?

If you selected "I/We need training," please go to our CPR/AED class schedule to find training that meets your needs.

Upon submission, you will receive a confirmation copy of the information you submitted, which may be printed for your records. Your entry will be added to the AED Registry database, and your local emergency service agency/agencies will be notified of the location of your AED.

 

 

600 Broadway, Suite 300
Kansas City, MO 64105-1554