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Mobile Clinic Vaccination and Community Event Request

For Mobile Clinic Vaccination Outreach Requests, please review the event requirements prior to submitting a request.

Community Event Request Form

You are not required to identify yourself or submit any personal information. However, it will be helpful should we need to contact you for additional information.

Under Florida Law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity.

Program / Service Line:
maximum 1 allowed

Mandatory field(s) marked with *