Vaccine Events Sign-Up

Required Info for Onsite Business Vaccination Request

The Northwest Arkansas Council, in collaboration with NWA health care systems and major employers, is available to host pop-up COVID-19 vaccination clinics across the region. If you are interested in hosting a clinic at your business, organization, place of worship or event, please fill out the form below. We may have more availability in the upcoming days. If none of the listed dates work for your group, please contact Ryan Cork at ryan@nwacouncil.org to request another date. One week advance notice is preferred.

Primary Contact Name *

Primary Contact Email *

Primary Contact Phone Number *

Secondary Contact Name *

Secondary Contact Email *

Secondary Contact Phone Number *

Business Name *

Business Type *

Business Address *

Business Address

City