Thank you for your interest in participating in Sleeves Up for Summer! Please let us know about your event by completing the questions below.  Thank you!

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* 1. Please provide your contact information.

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* 2. Please describe the event.

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* 3. Please list date, start and end time of the event.

Date
Time
Date
Time

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* 4. What is the expected number of doses?

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* 5. Are you requesting assistance for a one-time or recurring event?

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* 6. Do you need a vaccinator at your event?

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* 7. Are you interested in hosting an educational event and need assistance or a speaker?

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* 8. Will you or someone else be available to assist/manage the booth for the duration of the event?

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* 9. What will be provided at this event? (select all that apply)

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* 10. Do you need resources for your Sleeves up for Summer campaign? (select all that apply)

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