COVID-19 Vaccination Record Card

First Name

Last Name

ETBU email address

Phone

Vaccine Manufacturer

Date of First Vaccination

Date of Second Vaccination (if applicable)

Please upload your COVID-19 Vaccination Card Here

Please upload your COVID-19 Vaccination Card Here
One file only.
75 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.