JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
mRNA for all: share the COVID-19 Vaccine
More info? Contact us:
contact@mrna4all.org
Sign in to Google
to save your progress.
Learn more
Your name
Your answer
Your email address
Your answer
Are you part of the Moderna trial?
Yes, the trial for the original vaccine that now has EUA
Yes, a booster trial
No
Other:
What trial site are you enrolled in?
Your answer
Would you like your name to be added to a public letter calling for increased vaccine production?
Current draft of public letter:
https://docs.google.com/document/d/1JTDFQJDluPT1QZRsO59c2APkmlpUR1LR27rTRfI_97Q/preview
Yes
No
Other:
Clear selection
Do you plan to send this letter to Moderna?
Yes
No
Maybe
Clear selection
Any feedback?
Your answer
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
Forms
