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Chicago Covid-19 Masks Production Log
VERY IMPORTANT *Before filling out this form please confirm that masks have been washed or pre-washed before pickup.*
If you have at least 10 Masks completed or n95 Masks in hand please fill out.
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Email
*
Your email
Full Name
*
Your answer
Neighborhood
*
Your answer
Address
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Number of masks created
*
Your answer
Weekend Pick Up Preference
Morning (8am-12pm)
Afternoon (12pm-4pm)
Evening (4pm-8pm)
Saturday
Sunday
Morning (8am-12pm)
Afternoon (12pm-4pm)
Evening (4pm-8pm)
Saturday
Sunday
Curbside or PO Box
*
Curbside Pick Up
PO BOX. Please mail to Lauren Nepomuceno PO Box 221658 Chicago, IL 60622
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