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MyGate COVID Vaccination Drive
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1.
Your Information
(Required.)
Email ID
City
Society Name
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2.
How many people in your household would receive the vaccine via this drive?
(Required.)
*
3.
How many of these need only the second dose?
(Required.)
*
4.
For members taking the first dose, would you prefer second dose at your society premises?
(Required.)
Yes
No
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5.
Which of the following vaccines would you be open to getting?
(Required.)
Covaxin
Covishield
Sputnik
Any government approved vaccine
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6.
Are you willing to pay a nominal service charge for bringing the vaccination drive to your society, above the cost of the vaccine?
(Required.)
Yes
No
