COVID-19 Vaccinations Sign Up
Ebenezer Baptist Church, 101 Jackson St NE, Atlanta, GA 30312 is a COVID-19 vaccination site. All Georgia adults, aged 16 and older are now eligible to receive the vaccine. Vaccinations will take place inside the EBC banquet hall.  

Fulton County will be onsite at Ebenezer on April 28 and April 30 to administer the Pfizer vaccine.


Sign in to Google to save your progress. Learn more
Email *
What is your first and last name? *
What is your date of birth? *
MM
/
DD
/
YYYY
What County do you reside in? *
What is your phone number? *
What is your ethnicity?
Select a date for your vaccination appointment.
Select a time block for your vaccination appointment.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms