Download Guide Form

Thank you for your interest in Vote & Vax clinics. We hope you decide to participate in a program that will help you deliver flu shots to your community.

Before downloading the Setting Up a Successful Clinic resource guide, please complete this simple online form and acknowledge your agreement to the Vote & Vax operating principles that you must uphold should you choose to host or support a Vote & Vax clinic(s).

Last Name*

Email Address*

Organization*

Phone Number

Address

City

State

Zipcode

Vote and Vax Principles of Operation:

Agree to work in collaboration with local election authorities and in strict accordance with local election requirements.
Agree to abide by all local election authority regulations regarding the placement of activities in proximity to polling places.
Agree not to engage in any political activity in connection with operating a Vote & Vax Clinic.
Agree that the vaccination program will be carried out by or in cooperation with local public health authorities.
Agree that your Vote & Vax clinics must offer flu shots at polling places under the same terms as offered in other flu clinics in the area. That is, Vote & Vax clinic should adhere to the policies that apply at your agency's other community-based clinics. The integrity of the Vote & Vax project depends on assuring politically equitable access to immunization services.
Agree not to engage in "get out the vote" activities related to Vote & Vax clinics.
Agree to offer vaccinations to persons regardless of whether or not they have voted or are registered to vote.

* Required Fields. These principles apply to any organization that chooses to host or support a Vote & Vax Clinic(s). Agreeing to these principles does not obligate participation.