2023 Highway to Health Expo
Sunday, October 22, 2023
Shirt Size for Member only! Dependents are not eligible to receive a free t-shirt
Please provide the member's shirt size for FREE Highway to Health Expo t-shirt. Must be in attendance to receive!
Shirt Size for Spouse (if applicable) only! Dependents are not eligible to receive a free t-shirt
Please provide your spouse's shirt size (if applicable) for FREE Highway to Health Expo t-shirt. Must be in attendance to receive!
Best Contact Number:
Please enter a valid phone number.
MOE ID Number
Please note that this is not your Union Registration Number! The MOE ID number is a 9-digit number that can be found on your Medical ID card and your MOE Vendor card.
Member's Email Address:
How many eligible adults* (ages 18 and older) from your family will be in attendance for this event:
*Please include everyone over the age of 18, even if they are not planning on receiving a free service.
How many eligible children* (under the age of 18) from your family will be in attendance for this event:
*Please include everyone under the age of 18, even if they are not planning on receiving a free service. If none, please enter a "0".
Would you or anyone in your family like to get a flu shot?
If yes, please indicate which flu shot and the number of flu shots you are requesting for you and your family.
1 Flu Shot
2 Flu Shots
3 Flu Shots
Please indicate the quantity of flu shots needed.
Regular Flu Shot
(Available for ages 3 & older)
High Dose Flu Shot
(For ages 65 & older only)
Egg Free Flu Shot
Should be Empty: