Free COVID-19 Home Tests and KN95 Masks For the Injured Worker Community
Injured Workers Community Legal Clinic has received some COVID-19 home test kits and KN95 masks at no charge from the Red Cross for sharing with our community. If you would like to receive some of these please fill out the form below and we will mail them to you as long as our supplies last.
Name
*
First Name
Last Name
Address
*
Street Address
Apartment/Suite Number
City/Town
Province
Postal Code
Your email address is not required. However, if you would like to be added to the email list of Injured Workers Community Legal Clinic and receive notice of events and issues in the injured worker community, please put your email address in the box below:
example@example.com
Comments (optional)
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform