COVID-19 Phase 3 Vaccination Registration Form
The following people are considered eligible for vaccination in Phase 3
Name
First Name
Last Name
Email
example@example.com
Phone Number
County
City/Town
Phase 3 Group
Workers in industries important to a functioning society and at moderate risk of exposure as listed in the executive orders, such as restaurant workers, hairstylists, barbers, etc
Young adults aged 16 to 39
Other
Other
Only certain health departments currently have vaccine. Please select which health department you prefer to be contacted by for your vaccine appointment:
Columbus
Dooly
Crisp
Talbot
Chattahoochee
Marion
Taylor
Stewart
Clay
Quitman
Randolph
Schley
Macon
Harris
Webster
Sumter
Submit
Should be Empty: