AED Registration Form Please take a minute to complete this form and register your AED. This is a very important step in helping us save lives. When you register your AED, the information on the form will be put into the 9-1-1 Centers’ computer. Once your AED location is registered, if anyone calls 9-1-1 from your location we can advise them there is an AED on site. The 9-1-1 Emergency Medical Dispatchers call then assist the caller in using the AED, even if they have never seen one before. Please be very specific as to where the AED is located. It is most helpful if the exact location of the AED can be entered into the 9-1-1 center computer. For example, please list floor, office number, or other information that will help an individual find your AED in the event of an emergency. Rest assured that this information will only be shared between the North Carolina Office of EMS and The Alexander County EMS System. We will not disclose the information to any other parties without contacting you first. Thank you for purchasing and registering your AED. Your commitment may well save lives. Should you have any questions, please do not hesitate to contact Alexander County E-911 Communications at (828) 632-1737. Business Name*Contact Name* First Last Street Address (No PO Boxes)* Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* AED Type / Model*AED Location*AED Purchase Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 This iframe contains the logic required to handle Ajax powered Gravity Forms. * What is an AED?