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COVID Info
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Vaccine Event Host
Vaccine Event Host
Interested in having a vaccine event to be hosted at your site? But do not have the resources or team to arrange this? We got you!
Name of School/Organization/Company
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Location of Vaccine Site
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Indoor or Outdoor Event?
Indoors
Outdoors
Date
(Required)
MM slash DD slash YYYY
Time
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
Number of COVID Test Kits Needed (10-1000)
Please enter a number from
10
to
1000
.
