Mask Request Form

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Mask Request Form

Your Name *

Phone Number *

Email *

Preffered contact method *

Phone

What organization do you represent? *

What population does your organization serve? *

What city/area of Whatcom County is your facility located in? *

Who will you be giving masks to? *

Staff

Clients

Public on Request

Other:

Required

Which of the following type of mask are you interested in receiving? *

Respirator Mask, KN90 with Ear Loops

Respirator Mask, KN90 with Headband

Respirator Mask, N95, with Head Straps, BYD

Small kn95 for Small Faces with Ear Loops

Required

How many masks of each type are you interested in receiving? *

We may be able to provide other forms of masks later in February/early March. Is there a kind of mask you would be interested in that isn't listed above?

Are you, or another representative, able to pick up masks in Bellingham? *

Yes

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