We're collecting stories about people's positive vaccine experiences.

If you are interested in sharing how vaccines have had a positive impact on your life/your family, please share your story. 
Stories posted on our "Vaccine Stories" page on our website or social media platforms will only contain the information you provide in the "MY VACCINE STORY" box below along with a date stamp when the story was provided to us.
Required fields of information - The red asterisk " * " indicates required fields of information.

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* 1. First Name (will not be used on website/social media)

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* 2. Last Name (will not be used on website/social media)

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* 3. Email (We ask for an email address in the event we need to follow up with you regarding your story. Your email address will not be shared publicly)

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* 4. My Vaccine Story (this can be about any vaccine)

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* 5. ImmunizeAR may publish your "My Vaccine Story" on the ImmunizeAR website/social media platforms.

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* 6. ImmunizeAR may share my story and name to help educate legislators about the positive effects of vaccines.

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* 7. Would you be interested in speaking publicly about the positive impact vaccinations have had on you/your family?

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* 8. Thank you for taking time to fill out this form.

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