1. RN Recruitment for H1N1 Vaccine Campaign

Thank you for generously donating your time to assist the McHenry County Department of Health and our partners with this vaccination effort. You will be contacted by the Medical Reserve Corps Coordinator shortly for verification and additional information.

* 1. First Name

* 2. Last Name

* 3. Address

* 4. Phone Number

* 5. Current RN License Number

* 6. When would be the best time to contact you? (Choose all that apply)

* 7. When would you most likely be available to volunteer? (Choose all that apply)

* 8. What is the maximum shift length you would be able to work?