Use this Form to Indicate Your Official Support of the “Call to Action to Protect All Adults from Vaccine-Preventable Disease and Disability”

If your organization is interested in supporting the Call to Action but would like to receive more information about this step, please email us at info@izsummitpartners.org

Call to Action

* indicates required field
Confirm Your Organization’s Support of the Call to Action for Adult Immunizations
Organization*
Organization Website*
Type of Organization (choose one)*
- Professional society or organization
- Federal agency
- State or local health department
- Academic institution
- Community immunizer
Name*
First Last
Title*
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Phone*
Confirm Your Organization’s Support of the Call to Action for Adult Immunizations
Check box below
- My organization supports the Call to Action for Adult Immunizations
How Your Organization Supports the Call to Action for Adult Immunizations
In the space below, briefly share with us the specific ways your organization supports the Call to Action for Adult Immunizations. (Note: With your permission, this information will be included on the NAIIS website.)
File Upload (if applicable, share related documents and files)
Drop files here or

Max. file size: 1,000 MB.
List of Organizations Supporting the Call to Action for Adult Immunizations
- Yes. Update the NAIIS website with my organization's name and related information.

Use this Form to Indicate Your Official Support of the “Call to Action to Protect All Adults from Vaccine-Preventable Disease and Disability”

Call to Action

Confirm Your Organization’s Support of the Call to Action for Adult Immunizations

Confirm Your Organization’s Support of the Call to Action for Adult Immunizations

How Your Organization Supports the Call to Action for Adult Immunizations