COVID-19 Mobile Community Vaccination Clinic Request Form

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We Are Ready for Life (W.A.R.4Life), a Durham-based organization that works
with local governments, non-profit organizations, civic associations and other
neighborhood groups to expand economic opportunities for residents in historically
overlooked and underserved communities, will deploy mobile COVID-19 vaccination
units to reach North Carolinians in overlooked and undeserved communities.

The mobile vaccination units and community vaccine clinics will target low-income, racial-ethnic minority, immigrant, rural populations, and other collaborators throughout the state beginning in April 2021.

**Please allow up to 2 Weeks for WAR4Life to contact you with further details. **

Event POC Name *

Event POC Phone Number *

Name of Host Site (if applicable)

Organization Name

Organization Website

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