Village of Woodridge COVID-19 Vaccine Communications Registration

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The Village of Woodridge is interested in collecting the names and information of Woodridge residents in order to quickly and effectively communicate any future COVID-19 vaccination events or clinics. To be included on this list, please complete the following form. Please note that completion of this form does not guarantee access to a vaccine. For more information on the vaccination process, please visit https://www.dupagehealth.org/667/COVID-19-Vaccine

I am a resident of the Village of Woodridge interested in receiving more information about vaccination opportunities for Village residents. *

Yes

Description of DuPage County Phasing Plan

Please read the category descriptions in the image above. Based upon those, which category would you consider yourself to be in?

Phase 1a

Phase 1b

Phase 1c

Phase 2

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First Name *

Middle Name

Last Name *

Street Address *

City *

Zip Code *

Date of Birth *

YYYY

Land Line Telephone (Optional)

Cell Phone (use the preferred cell number to contact you)

E-mail address (use the preferred email address to contact you) *

Re-enter email address *

Submit

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