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2. Inquiry Form
   Anoka County Public Health is planning for COVID-19 vaccination of individuals identified in the Minnesota Department of Health (MDH) allocation and prioritization guidance. As MDH directs use of vaccine for identified priority groups, the primary contact will receive an email of vaccination opportunities from Anoka County Public Health, so please ensure that the contact information for your organization is accurate.
4. Organization Name:*
6. Organization Street Address:*
7. Organization City:*
8. Organization Zip Code:*
10. Organization Type*
    -- Select One --Food ProcessingAgriculturalAirportChild CareCorrectionalFirst RespondersFood ProductionFood RetailFood ServiceJudicial SystemManufacturingPublic HealthPublic TransitPostal ServiceOther
11. If Other:
15. Contact Name:*
16. Contact Position:*
18. Contact Phone (including area code):*
19. Contact Email:*
21. Preferred contact time range:*
22. Preferred contact method*
    -- Select One --PhoneEmail
24. Number of Employees/Personnel:*
    If this does not apply to you, enter 0.
25. Number of Residents:*
    If this does not apply to you, enter 0.
27. Additional Notes
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field