Application for AED Program Click here to view/print a paper form that you can mail/fax to SVMCA. Type of application:  Initial Renewal Replacement Date:  Organization Information Name of organization/AED owner:   Manager/director/administrator of above organization:   Title:   Organization's mailing address:   Phone #:   Fax #:   AED Information Name of AED site:   Site Address: (Physical address, not mailing address)   AED program coordinator:   Specific location of AED within site: (Please be as specific as possible)   Brand of AED/serial #:       Biphasic Monophasic Unknown Expiration dates:   Battery Pads Adult Pediatric Is AED a replacement?:   Yes No If yes, list brand and serial # for old unit: Program Type:  (check all that apply) Private corporation - Profit Airport Construction site Non-profit - Private Store - Open to public Stadium/sports/gathering place Government agency Business/office complex School/college Industrial complex Other: Training:  (check all that apply) AHA HeartSaver AED American Red Cross National Safety Council # trained personnel:  Additional projected (if any)  Will the general public (people not affiliated with the AED program) have access to use the AED?    Yes No