Swissvale Vaccine Distribution Interest Form

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Hello!

Thank you so much for taking your time to fill out this quick form.

Fred Quinn and Angela Stribling are working with Central Outreach Wellness Center, located on Pittsburgh's North Shore, to bring a Pfizer Vaccine Day to Swissvale on May 22nd, 11-AM - 3 PM at the Greater Swissvale Community Food Pantry, 2028 Noble Street, Swissvale, PA 15218. You WILL receive your appointment for the second vaccine shot after your first shot on May 22nd!

If you know a friend/neighbor/relative in Swissvale (or surrounding areas) that still needs the vaccine. If you can fill this form out with your first and last name and email, we can get back to you as soon as possible with event details!

First Name *

Last Name *

Email address *

Phone Number *

Best way to contact you? *

Phone

Where are you located? *

Swissvale

Rankin

Braddock

Edgewood

Wilkinsburg

Regent Square Neighborhood

Other:

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