Mt. Oliver: Vaccine Registration Form
Bethany Community Ministries is hosting a 2nd COVID-19 Vaccination Event at Mt. Oliver Fire Station in partnership with 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.

Event Date: Saturday, March 26, 2022
Location: Mt. Oliver Fire Station
120 Brownsville Road, Pittsburgh, PA 15210
Time: 10:00 AM to 12:00 PM
Eligibility: Ages 5+
Cost: FREE

Get $25 from BCM if you're one if the first 150 vaccinated!

Vaccines Available:
- Pfizer (2-step): Ages 5 & up
- Moderna (2-step): Ages 18 & up
- Johnson & Johnson (1-step): Ages 18+

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First Name *
Last Name *
Phone Number *
Phone Type *
Email Address *
Zip Code *
Date of Birth *
Race *
Ethnicity *
Gender *
Who is your insurance provider?
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Which vaccine do you want to receive?
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Which dose will you be receiving?
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