Uber voucher EOI(Expression of Interest) for Multicultural communities in NSW
Good Neighbors Australia (ABN 95 510 669 822) is a government registered charity dedicated to helping our
neighbours in Australia and across the world. With the financial support of the NSW state government, we are providing an Uber ride voucher to help our CALD(Culturally and Linguistically Diverse) communities get vaccinated to the maximum level.

1) If you plan to get vaccinated between Oct and Dec 2021, or 2) if you plan to get a booster shot between Jan and Mar 2022, complete the form to register your interest in receiving an Uber voucher. On the basis of your information, you will be contacted by our staff for confirmation.

** The information collected is only used to contact you and is secured against unauthorised use or access. If you require any further information, please contact us at vaxx@goodneighbors.org.au**
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Name *
Mobile number *
your email(to receive your Uber ride voucher) *
Date of your first dose
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DD
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YYYY
Date of your second dose
MM
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DD
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YYYY
Do you plan to get a booster shot?
Clear selection
Date of your booster shot planned (if applicable)
MM
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DD
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YYYY
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