Audrain County Health Department (ACHD)

Join Team Audrain!

Please fill out the information below to enroll in Team Audrain and receive your free COVID-19 vaccination lapel pin. Allow up to 2 weeks for delivery. Thank you for your support! Together...we'll beat COVID-19.

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* 1. Yes...I want to join Team Audrain to support the current COVID-19 vaccination efforts.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

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* 2. What type of vaccine did you receive?

Moderna

Pfizer

Johnson & Johnson

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* 3. Would you be willing to provide ACHD a personal endorsement of why you got vaccinated?

Yes

Audrain County Health Department (ACHD)

Join Team Audrain!

Question Title

* 1. Yes...I want to join Team Audrain to support the current COVID-19 vaccination efforts.

Question Title

* 2. What type of vaccine did you receive?

Question Title

* 3. Would you be willing to provide ACHD a personal endorsement of why you got vaccinated?

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* 4. What is your cell number?

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* 5. How may lapel pins would you like? You can request up to 3 pins.