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Senior Vaccine Priority Registration
You must be over 65 in order to qualify
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* Indicates required question
Email
*
Your email
Are you over 65?
*
Yes
No
Full Name
*
Your answer
Street Address
*
Your answer
Town
*
Your answer
Zip
*
Your answer
Contact Number
*
Your answer
Email Address (if available)
*
Your answer
Date of Birth? (MM/DD/YYYY)
*
Your answer
Do you have any mobility issues or require accommodations we should be aware of?
*
Yes
No
Are you willing/able to travel to the Meadowlands mega-site if an appointment is available sooner that way?
*
Yes
No, I need/want a local appointment
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