StaySafe Pop-up Interest Form
Thank you for your interest in the StaySafe program! Please use this form to tell us a bit more about yourself and why you want to run a StaySafe Rapid Screening Pop-up
What is your name (first and last)? *
What is your email address? *
What is your phone number?
What is your age range? *
Have you previously been involved with rapid testing? *
Will your rapid screening pop-ups be open to the general public or for a private group only?
Clear selection
Briefly describe the group for whom you are looking to provide rapid screening. *
How frequently do you expect to run a rapid screening pop-up?
How many rapid tests do you expect to need for each pop-up?
Thank you for your submission. You will receive an email with next steps within 48 hours. In the meantime, if you have any questions please reach out to
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