Vaccine Appointments at St. Paul Church Tuesday, Jan. 18, 2:30-5:30
Please complete this form to signup for a COVID-19 vaccine at:

St. Paul Church
3912 Gus Young Ave,
Baton Rouge, LA 70802
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First name: *
Last Name: *
Street address (#### Street) *
Zip code *
Cell Phone (including area code; so we can text you a reminder.) *
Email address
Which dose are you receiving? *
If you would like to register additional members of your household, please list their full name(s) below in the space provided:
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