Vaccine Commitment | Take the Pledge

First Name:

Last Name:

Email:

Name of Business:

Zip Code:

Free Text

I pledge to be a small business vaccine leader!

I plan to commit to the following (choose as many as you can commit to):

I pledge to be a small business vaccine leader! I plan to commit to the following (choose as many as you can commit to):

Commit to getting the vaccine when it is my turn and let my employees know why I am choosing to get the vaccine.

Create a vaccine plan for me and my employees.

Provide incentives to employees who receive the vaccine (e.g., paid time off to receive the vaccine).

Continue to follow state and federal guidance on social distancing and wearing masks after me and my employees are vaccinated.

Assist with vaccine promotion and distribution in my community (e.g., volunteer to help at COVID-19 vaccination sites, donate supplies or services to vaccination sites, and/or be vocal in my community on the business case for getting vaccinated).

Other

Other:

Free Text

I am:

I am:

Small Business Owner

Small Business Leader (Run a chamber of commerce, business organization, etc.)

Other

Other:

Free Text

By checking this box, I am committing to be a vaccine leader and give permission for my name and the name of my business to be shared on the Reimagine Main Street website (www.reimaginemainstreet.org). *

Yes, I commit and give permission.

No, I do not commit.

Free Text

I would be interested in the following *

Speaking with a reporter about my commitment.

Being added to a communications listserv to receive updates that can help me, my employees, and community.

Creating a video about my commitment.

Writing an op-ed or letter to the editor (with help) about my commitment.

Speaking at an event about my commitment.

Attending an educational event about vaccines or public health with other business leaders.

I am not interested in any of the above.

Free Text

How do you identify yourself? (Select all that apply). *

Asian American/Pacific Islander (including Japanese American, Korean American, Filipino American, Southwest Asian American, Vietnamese American, and Chinese American)

Black, African or African American

Hispanic, Latino

Native American or Alaska Native

White or Caucasian

Prefer not to answer

Other:

take the

VACCINE pledge

Small Business Vaccine Leader Pledge

Contact Us