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COVID Vacuna Lista de Espera (WAITING LIST)
Por favor, complete este formulario para colocarse en la lista de espera para la vacuna.
Complete this form to be on the waiting list for the vaccine.
https://am-i-eligible.covid19vaccine.health.ny.gov/
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Primer nombre (First Name)
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Apellido (Last Name)
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Fecha de Nacimiento (Date of Birth)
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YYYY
Dirección Línea 1 (Address Line 1)
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Dirección Línea 2 (Address Line 2)
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Ciudad (City)
Staten Island
New York
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Brooklyn
Bronx
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Estado (State)
NY
NJ
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Código Postal (Zip Code)
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Número de Teléfono (Phone Number)
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Tipo de Trabajo (Type of work)
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