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?
Yes, I have previously volunteered with StaySafe
Yes, my company has implemented a rapid testing program
Yes, I have previously visited a StaySafe rapid testing location
Yes, I have previously visited a rapid testing location (not StaySafe)
Will your rapid screening pop-ups be open to the general public or for a private group only?
Open for the public
Private group only
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 email@example.com.
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