Canvas Institute COVID-19 Vaccine Forum Registration Survey (5/29)
Thank you for your interest in our forum. Please take a moment to fill out this survey so that we can register you for the event. Registering for the event early will qualify you for a FREE COVID Survival Kit, compliments of Clifton Medical Plaza. We look forward to seeing you on Saturday!
Email *
First Name *
Last Name *
Phone Number
How did you hear about the COVID-19 Vaccine Forum? *
Age Group *
Would you identify yourself as a Person of Color? *
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