1199SEIU Face Mask and Glove Distribution
Sign in to Google to save your progress. Learn more
1199SEIU has been on the forefront of fighting for much needed protections during this vulnerable time. Our union has a very limited supply of face masks and gloves available to Personal Care Attendants on a first come first served basis.
To obtain 20 masks and/or 25 gloves please complete the form below.
First Name *
Last Name *
Street Address *
Apartment, Unit, or Floor number
City / Town *
State *
Zip code *
Cell Phone *
Home Phone
Email Address *
Please mail me: *
Glove size (Note: we cannot guarantee glove size) *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy