Thank you for your interest in helping get people vaccinated. Please complete this form if you are interested in hosting a mobile COVID-19 vaccination clinic at your organization. Host organizations must be in DeKalb County, Georgia, and include places of worship, nonprofits, businesses, schools, and community organizations. Completing this form is the first step to notify us of your interest, but it does not guarantee that we will fulfill your request.
If you need help with this form, please email firstname.lastname@example.org.
*=questions that are required