COVID-19 Vaccination for Foreign Residents of Chiang Mai: Never Vaccinated
This registration form is intended for those who still require COVID-19 vaccination in Chiang Mai and who fall into the following category:

Category 1: Foreign residents of Chiang Mai (this does not include migrant workers from Myanmar, Cambodia, Laos) aged over 18 yrs who have never received any form of COVID-19 vaccine.

Data will be collected once a month, for 7 days starting on first Monday of each month.

All enquiries to Foreign Affairs, Chiang Mai Provincial Office: chiangmai.fa@gmail.com

(Your data will be protected and only used by Chiang Mai Provincial Health Office for the purpose of your COVID-19 Vaccination)

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First Name *
Surname *
Date of Birth *
MM
/
DD
/
YYYY
Nationality *
Email Address *
Phone Number *
What District do you live in? *
What Sub-District do you live in? *
1.1  What COVID-19 Vaccine would you like to receive as first choice? *
1.2  What COVID-19 Vaccine would you like to receive as second choice? *
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