NJEMSTF
Individual EMS Provider Assistance
​FIFA World Cup 2026™

​**ADDITIONAL DAY(S) May Be Added**
This form is for use only by NJ EMS Providers expressing interest in assisting with coverage of FIFA World Cup 2026™ activities.  By completing this form, you are only expressing interest in the assets and/or events listed.  This is not a commitment.  A Professional Services Agreement with your host/sponsoring agency and a Certificate of Insurance will be required if services are accepted.  Any reimbursement, if available, will be limited to earned overtime only.   There will be no reimbursement for equipment, base rate, fringe, mileage, etc.   We will coordinate through the FIFA World Cup EMS Operations Center ([email protected]) and your assigned Module Manager/Task Force Leader/Crew Boss.   

    FIFA World Cup 2026™ - EMS PROVIDER Assistance

    ​If your agency is not listed here, CONTACT YOUR AGENCY ADMINISTRATOR TO COMPLETE AN AGENCY INTEREST FORM BEFORE YOUR REQUEST CAN BE PROCESSED. 

    Payroll Information
    By clicking SUBMIT, you agree that:
    By Checking here, you agree that you have received approval of your department supervisor, that your department is listed in the Agency list above, that you will be contacted to confirm work assignments before you deploy, and that you agree to submit daily 214 Unit Logs for each shift you are assigned too​
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