Chicago Mask Bloc - Free High-Quality Masks (KF94, KN95, N95+) and Rapid Antigen Test Distribution

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for filling out our request form! Our volunteers will be in touch. If you haven't heard back within a week, please email ChicagoMaskBloc@gmail.com

If you are looking to donate masks to us, please fill out our mask donation form instead.

Name and pronouns
*

I want... *

Masks only (50 masks per person)

Tests only (4 tests per person)

Masks and tests

I want to receive my items by... *

Items can be:

- Delivered to you by a volunteer, or

- Picked up from available neighborhood options: Andersonville, Avalon Park, Avondale, Chicago Lawn, Englewood, Hyde Park, Logan Square, Lake View East, Pilsen (C lick here to see a map of our locations!)

Delivery

Pick-up

What neighborhood do you live in? *

Email address
If you selected "pick-up", you will be sent an email with instructions. *

Phone number

Required to coordinate delivery! Your delivery driver will text you.

Address to coordinate delivery

Please note that all volunteer drivers will have access to this information, and that anyone can sign up to be a volunteer. For transparency, as of August 2024, 22 community members have access to this information. If you do not wish to share your address on this form, your delivery driver will text you directly for your address.

Please share any other info about how best to get masks to you!

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms