Vaccine Pop-Up Site Registration
Volunteer to provide COVID vaccines to patients in Memphis
Is your facility a medical clinic?
*
Yes
No
Do you have staff aavailable to administer the COVID vaccine?
*
Yes
No
Contacts Name
*
First Name
Last Name
Suffix
Contacts Phone Number
*
-
Area Code
Phone Number
Comments or Questions
Is your organization able to obtain at least 50 patients?
*
Yes
No
With Assistance from MMS
Submit
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