Vaccination Incentive Gift Card Request - Greater Fairbanks Chamber of Commerce, AK

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Vaccination Incentive Gift Card Request

Please fill out all required fields below to request gift cards for your vaccination event. Only healthcare providers may request the cards. If you are a site host for a pop-up clinic, please ask the vaccination provider to make the request.
Healthcare Organization Administering Vaccinations *

I am an employee or other authorized representative of this healthcare organization. *

Agree Disagree

Name Block - Full

Title

First Name *

Last Name *

Suffix

Phone Number *

Email *

Vaccination Event Date *

Vaccination Event Location

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Number of People You Expect to Vaccinate at This Event *

Number of Gift Cards Requested *

Requested Pickup Date (must be during Chamber business hours: M-F 8:00am - 5:00pm) *

Name of the Person Who Will Pick up the Gift Cards *

Next Steps

Our staff will review your request and email you with further instructions for pickup. We need at least 24 hours notice before you hope to pick up the cards. If less than 24 hours notice, please call our office after submitting the form to see if we can accommodate your request: 907.452.1105.
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