Senior Vaccine Priority Registration
You must be over 65 in order to qualify
Email address *
Are you over 65? *
Full Name *
Street Address *
Town *
Zip *
Contact Number *
Email Address (if available) *
Date of Birth? (MM/DD/YYYY) *
Do you have any mobility issues or require accommodations we should be aware of? *
Are you willing/able to travel to the Meadowlands mega-site if an appointment is available sooner that way? *
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