PBKNY COVID-19 Relief Initiative: Vaccination Registration
The PBKNY Young Professionals are launching a new COVID-19 vaccine registration initiative that will pair YP members with eligible members, and particularly older adults, who wish to schedule a vaccination date. If you would like to be paired with a YP member who will guide you through the process of securing a vaccination date and completing the necessary forms, please fill out this form. While at this time we cannot guarantee that we will be able to pair everyone with a volunteer, we will try to meet the demand as best as possible. 
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Name (First and Last)
Email Address
Where were you inducted into Phi Beta Kappa (University/College name)?
Year of Induction
Are you currently eligible to register for a COVID vaccine?
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Would you like to be paired with a volunteer who can help you fill out the online registration forms?
Clear selection
Please let us know if you have any questions:
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