Adult Vaccine Access Coalition Membership Sign-up
The Adult Vaccine Access Coalition (AVAC) seeks to raise awareness, improve access, and bring adult immunization rates in line with public health objectives. AVAC aims to be an inclusive partnership of organizations who share the desire to inform and engage policymakers towards common legislative and regulatory solutions that will strengthen and enhance access to adult immunization across the health care system. AVAC is thrilled to launch with the participation of broad group of stakeholders. Please use this form to add your organization as a member of the Coalition.
Would your organization like to join the Adult Vaccine Access Coalition?
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Organization
Address
Phone Number
Please list the name of the main point of contact for your organization who should receive AVAC information.
Title
Email
Please list a secondary contact for your organization (if applicable)
Title
Email
Name of individual to put forth for consideration.
Name of individual at your organization that AVAC should reach out to for further discussion on dues. Dues are tiered to reflect ability to pay. If your organization is a consumer, patient or public health organization or if you are a policy expert there are no dues to join our coalition.
Does AVAC have permission to use your logo on AVAC's website?
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Is your organization able to help by providing conference room space for future AVAC meetings?
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Please provide any additional information that you wish to share.
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