SIGN UP FOR THE DRIVE-THROUGH FAIR NOW
Flu shots are an important part of health at this time of year. We're asking you to sign up now so we can contact you in advance to get you prepared for a flu shot -- which will be offered at the fair. You do not have to get a shot, but we strongly recommend it. Only adults will be vaccinated at this site. Please wear a face mask.
After you submit the form, someone from Lincoln Literacy or another agency will contact you about the process..
Need help?  Cần giúp đỡ    ¿Necesita ayuda?  تە هاری کاری ڤئت  Потрібна допомога?   需要帮助吗?   Besoin d'assistance?  Нужна помощь?    تەندورستی  
☎  402-476-7323  📲  402-475-3774. .


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First Name (or Given Name): *
Last Name (or Family Name): *
Do you have a car?  If "no" we may be able to give you a ride.
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How many adults will come with you on Dec. 19th?
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Please give us the names and phone numbers of adults who will come with you.
Your street address (you must live in Lincoln or within Lancaster County) *
State: *
Zip Code: *
Cell Phone Number: *
Other Phone?
Email:
Gender *
Please type your date of birth *
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Country of Origin: *
What languages do you speak? *
How do you identify? *
Check as many boxes as you need to.
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What is your status? *
Do you have any children at home under the age of 19?If yes, we will provide information about how they can get vaccinated. *
THANK YOU. Please click the "Submit" button below, and someone will contact you. Then, we'll see you on Dec. 19th!
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