Mask Request Form

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Mask Request Form

Dear Community Members:

To help reduce the spread of the COVID-19, Asian American Center of Frederick (AACF) is currently distributing cloth masks that are sewed by our volunteers.

This cloth mask, however, WILL NOT prevent you from getting COVID-19, but will help the person wearing it to reduce the spread of germs. You still need to follow the guidelines established by CDC to stay well.

Please fill out a short form below. After your request is sent, it will be reviewed and added to our list. We will notify you once the masks become available.

Also, if you know someone who is able to sew, please kindly let us know.

Remember there is a waiting list and we will do our best to accommodate your requests as soon as they become available.

Questions? Email to operations@aacfmd.org, or rsvp@aacfmd.org. Thanks for your interest!

Sincerely,
AACF Mask Project Team

Asian American Center of Frederick
1306 W Patrick Street, Unit 5A
Frederick, MD 21703

Name (First, Last) *

Phone Number *

Email *

Organization

Reasons for Masks *

For myself (limit to 2)

For my family (limit to 5)

For my neighbors or friends (limit to 5)

For an organization

Other

If your answer is For an organization, or Other, please explain.

Number of Masks Requested *

Number of Child Masks requested

How did you hear about our Mask Project? *

AACF Website

Social media

Word of mouth

Radio/TV

Other

Please note that this cloth mask WILL NOT prevent you from getting COVID-19, but will help the person wearing it to reduce the spread of germs. *

Yes, I have read the disclaimer.

Signature (By typing my name below, I am electronically signing my request form.) *

Date *

YYYY

Submit

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