TAPI Community Ed - Organization Request

Education About Vaccines for Your Community

Many organizations are interested in providing education about vaccines to the communities they serve. Our state vaccine coalition, The Arizona Partnership for Immunization (TAPI), is available to help connect community organizations with volunteer physicians, nurses and other public health experts to provide this education. If you are interested in providing the communities you serve with education about vaccines, please complete the following survey.

If you don't know answers to ALL of the questions, that's okay. Please fill out what you DO know. Any information you can provide will be useful!

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* 1. Organization

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* 2. Primary Contact First & Last Name

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* 3. Primary Contact Phone Number

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* 4. Primary Contact Email Address

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* 5. 2nd Contact First & Last Name (In case we are not able to reach Primary Contact)

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* 6. 2nd Contact Telephone Number

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* 7. 2nd Contact Email Address