COVIDCARD Registration Form

Register Your Blue Planet Vaccination Card

What type of tag are you registering?
The registration information will not appear on this site.

Enter Alert Number:

Enter Alert Number Again:
(mandatory)

Enter your primary email address below:
Enter Email Address:

Enter Email Address Again:
(mandatory) (Example: name@domain.com )

Please complete the following section:

Name:
Street Address:
Apt. No./Other:
City:
State:
Country: U.S. or Canada Only.
ZIP Code/Postal Code
Home Phone:

Cell Phone:

Name/City/State of Retailer:

Please provide any additional contact information and power of attorney.