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Bedford Dwellings: Vaccine Registration Form
Bethany Community Ministries is hosting a COVID-19 Vaccination Clinic at Bedford Dwellings in partnership with the Black Equity Coalition, Neighborhood Resilience Project, Highmark, Allegheny Health Network, and PCHS. Please complete this form to pre-register for the event. Children under 18 must be accompanied by an adult to receive the vaccine.

Get $50 from BCM when you pre-register and get your COVID vaccine!

Vaccines Available:
- Pfizer (2-step): Ages 5 & up
- Moderna (2-step): Ages 18 & up

Date: Thursday, August 11, 2022
Location: Bedford Dwellings
2283 Somers Drive, Pittsburgh, PA 15219
Time: 1:00 pm to 4:00 pm
Cost: FREE!
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First Name *
Last Name *
Phone Number *
Phone Type *
Email Address *
Zip Code *
Date of Birth *
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Race *
Ethnicity *
Gender *
Who is your insurance provider? *
Which vaccine do you want to receive? *
Which dose will you be receiving? *
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