IGotTheShot-Blue_No Background.png

We're supporting our AAP-CA3 members in promoting the COVID-19 vaccine. Please fill out this form to request your #IGotTheShot items, and we'll do our best to fulfill your request while supplies last. PLEASE COMPLETE THIS FORM USING THE GOOGLE CHROME BROWSER or go to the updated link: http://survey.constantcontact.com/survey/a07ei9rlv5wkr2c27qa/start Email info@aapca3.org with any questions or problems, or feel free to email us your order directly if you have any trouble with the form. Make sure to hit SUBMIT at the bottom of the survey.

* First & Last Name, Title
0/50
* Medical Group
0/50
* Email address
0/50
How many #IGotTheShot STICKERS would you like for your office? (Max 100)
0/50
How many #IGotTheShot BANDAGES would you like for your office? (Max 100)
0/50
How many #IGotTheShot VACCINE CARD HOLDERS would you like for your office? (Max 20, limited supply available soon).
0/50
How many #IGotTheShot BUTTONS would you like for your office? (Max 10).
0/50
* Street Address For Shipping
0/50
* City, State, Zip Code for shipping
0/250