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2. First Name*
3. Last Name*
5. Phone Number*
6. E-mail Address*
8. 
10. Are you interested in receiving a Take Care Kit?

    If so, we have the below complimentary items available (while supplies last). Please select the items that you would like to receive.

    1. Masks

    1. Buttons

    1. Window Clings

    1. Yard Signs
12. Please list the quantities you'd like to receive in your Take Care Kit.
14. **The Take Care Kits will not be mailed, they will need to be picked up from the Douglasville Welcome Center.**
    Located at 12385 Veterans Memorial Hwy., Douglasville, GA 30134. Hours of Operation: Monday - Friday | 8 AM - 5 PM
16. Would you like to be featured on the City of Douglasville's Social Media pages?
    If so, please list your Social Media handles.
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

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