Neighborhood Vaccination Event - Interest Form

Thank you for your interest in the upcoming vaccination event on March 12-13!

Do you live in one of the following Zip Codes: 90062, 90043, or 90037?  If so, you may be eligible to receive a free vaccination to protect you from COVID-19.  

To be eligible you must be in at least one of the categories below:

  • 65+
  • Healthcare Worker 
  • Education/ Childcare Worker
  • Food and Agriculture Worker
  • Emergency Services Worker

Please fill out the following information so that we can call you to set up an appointment. 

You MUST fill out your contact information so that we can call you to reserve a slot on March 12 or 13.

116 RSVPS

Intake Form


Support OneLA-IAF