COVID-19 Vaccine Transportation Aid

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

City

State

What is your vaccine priority group? *

Please enter the vaccine priority group you are under. Click here for group descriptions

Please select a ride share app you have used or will use to get to and from the testing site

Have you already been vaccinated? *

If you have already traveled to get the vaccine, please upload proof of vaccination and proof of travel.

Click or drag files to this area to upload. You can upload up to 5 files.

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