Mask Request Form - Mask Bloc ATX

This form is for individuals / families / households in Austin, TX area to fill out to receive free masks!

Currently we serve the city of Austin and can arrange contactless drop off deliveries for masks. Requests outside of the city will be considered via shipment. Or we may know a partnered Mask Bloc we could reach out to for help. Deliveries could take a week or more to fulfill and will depend on the capacity of the group.

If you are a business, group, venue, organizing an event or interested in handing out a larger number of masks-- please email us!

Feel free to email us with any questions: MaskBlocATX@proton.me

Links: https://maskblocatx.carrd.co/

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What is your name? *
What is your email address? *
Are you located in Austin, TX? *
What type(s) of mask would you like? *
Required
How many masks would you like of each kind? Please feel free to mix and match!  *
Do you need a type of mask that isn't listed above? We can do our best to acquire it. Let us know what kind and how many.
Any questions or concerns?
Please check to make sure your email address is spelled correctly :) *
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