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* 1. The Omni Board of Trustees has an opportunity to partner with a privately owned local pharmacy to administer the Moderna Covid-19 vaccination to anyone in our community (staff, family, relatives, friends) 18 and older. In order to proceed we need to gauge community interest to determine expected turn out. If this were clinic were held how likely would you or someone you know register and be vaccinated at this event?

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* 2. (OPTIONAL) If you responded that you or someone you know Might Attend or Will Definitely Attend please provide an estimate of the number of people in your group.

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* 3. (OPTIONAL) If you responded that you Would Not Attend please provide a reason

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* 4. (OPTIONAL) If you responded that you Might Attend please provide additional details as to why you uncertain so that we may be able to help address concerns.

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* 5. (OPTIONAL) If you have any general comments, questions or feedback about this event please list them here. Thanks!

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