Sleeves Up for Summer Interest Form

Thank you for your interest in participating in Sleeves Up for Summer!  This effort is focused on bringing new faces and energy to COVID vaccination efforts for the month of May.  We are asking business partners and community leaders across the state to be the face of this effort, with State support.  Please let us know how you are able to be involved by completing the questions below. Thank you!

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* 1. Name 

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* 2. Organization 

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* 3. Borough 

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* 4. City/community 

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* 5. Phone number 

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* 6. email 

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* 7. Are you interested in being part of your borough’s planning committee for Sleeves Up for Summer?

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* 8. Are you interested in being the Lead for your borough’s planning committee?

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* 9. Do you have resources you can contribute to Sleeves Up for Summer? (check all that apply)

I am a healthcare provider and can host a vaccination clinic at my own clinic/existing vaccination clinic site

I am a healthcare provider and can host a vaccination clinic at a business or other community location

I can donate incentives

I can host a vaccination clinic at my business/festival/community event (hosting a clinic will require some logistics management from host)

I can provide a service for a fee at a vaccination clinic (ex; music, food, entertainment, etc)

I can provide a service for free at a vaccination clinic (ex; music, food, entertainment, etc)

Other (please specify)

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* 10. Do you need resources for your Sleeves up for Summer campaign? (select all that apply)

I need communications resources such as flyers and posters.

I need help promoting my event through social media, radio or TV.

I want to add my event to the calendar of events on the Sleeves up for Summer website.

I need Sleeves up for Summer swag such as buttons or stickers.

I need a vaccination team to come to my business or event.

I need help adding fun to a vaccine event such as entertainment or music.

Other (please specify)

Sleeves Up for Summer Interest Form

Question Title

* 1. Name

Question Title

* 2. Organization

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* 3. Borough

Question Title

* 4. City/community

Question Title

* 5. Phone number

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* 6. email

Question Title

* 7. Are you interested in being part of your borough’s planning committee for Sleeves Up for Summer?

Question Title

* 8. Are you interested in being the Lead for your borough’s planning committee?

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* 9. Do you have resources you can contribute to Sleeves Up for Summer? (check all that apply)

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* 10. Do you need resources for your Sleeves up for Summer campaign? (select all that apply)

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* 11. If you selected yes on any of the above options, please provide additional details below

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* 12. Please provide additional thoughts, suggestions, or ideas below

Sleeves Up for Summer Interest Form

Question Title

* 1. Name

Question Title

* 2. Organization

Question Title

* 3. Borough

Question Title

* 4. City/community

Question Title

* 5. Phone number

Question Title

* 6. email

Question Title

* 7. Are you interested in being part of your borough’s planning committee for Sleeves Up for Summer?

Question Title

* 8. Are you interested in being the Lead for your borough’s planning committee?

Question Title

* 9. Do you have resources you can contribute to Sleeves Up for Summer? (check all that apply)

Question Title

* 10. Do you need resources for your Sleeves up for Summer campaign? (select all that apply)

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* 11. If you selected yes on any of the above options, please provide additional details below

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* 12. Please provide additional thoughts, suggestions, or ideas below

* 1. Name 

* 2. Organization 

* 3. Borough 

* 4. City/community 

* 5. Phone number 

* 6. email 

* 9. Do you have resources you can contribute to Sleeves Up for Summer? (check all that apply)