Latitude Vaccination Volunteer Interest Form

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Hello -- Latitude Food Allergy Care is excited to seek volunteers to assist in the implementation of its COVID vaccination program!

Over the next several weeks and months, volunteers will be contacted when there is a match in your interest and available positions.

*Note*
We are only accepting volunteers with a Healthcare background. All our Admin volunteer positions are full.

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Correo electrónico *

Declaration *

I consent to having my background checked against local and federal authorities including the Office of Inspector General's Exclusion Database.

Obrigatorio

Formal Full Name *

As listed on verification document

Preferred First Name

Mobile Phone *

Are you qualified and able to serve in a clinical role?

Yes

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