Marketing Support Opportunity Application: Educating Older Adults about the Benefits of Influenza and Pneumococcal Vaccination with Integration of Fluzone High-Dose Vaccine

Thank you for your interest in the marketing support opportunity for Educating Older Adults about the Benefits of Influenza and Pneumococcal Vaccination with Integration of Fluzone High-Dose Vaccine. Please complete this questionnaire to apply for marketing support. VNAA is accepting one submission per agency. Please provide as much detail as possible on agency clinics and the audiences served.

Please answer ALL questions for the application to be considered.

To pause this form and resume later, please use the "save" option at the top of the page. For those applying for grant funding, the questionnaire will be two pages. Be sure to click "next" at the bottom of the page.

1. Please list the amount of marketing support funds the agency requests to create and host educational sessions. *This question is required.

2. Please list the name of the agency name. (Only open to VNAA members) *This question is required. Please list the agency's full formal name, as this is what we will use to fill out contracts and checks, if selected.

3. Please list the agency billing address. *This question is required.

Street:
Suite:
City:
State:
Zip

4. Primary agency contact to receive all correspondence, updates and requests for this opportunity. *This question is required.

Primary Contact Name:
Primary Contact Title:
Primary Email:
Primary Phone Number

5. Secondary contact.

Secondary Contact Name:
Secondary Email:
Secondary Phone Number:

6. Will immunizations be administered during the sessions? *This question is required.

7. Will the agency submit a wrap-up report within two weeks of all sessions to include: location, number of attendees, photographs, copies of promotional materials, vaccines administered, additional vaccine doses over pre-booked amount needed/used, and a final description of marketing support fund allocation. *This question is required.

Marketing Support Opportunity Application: Educating Older Adults about the Benefits of Influenza and Pneumococcal Vaccination with Integration of Fluzone High-Dose Vaccine

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