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COVID-19 Vaccine or Testing Event Request Form

  1. What type of event are you interested in?*
  2. What items will be available for CHA use?*

    Check all that apply.

  3. Type of event*

    Check all that apply.

  4. Will there be support staff on site from your organization to assist with the clinic?*
  5. Would your organization like to host the follow-up (2nd dose) vaccine clinic?*
  6. Does your organization plan to handle marketing and promotion of the vaccine clinic?*
  7. Leave This Blank:

  8. This field is not part of the form submission.