Comprehensive Health Screening Registration
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which Location and time would you like to attend?
*
AIRPORT - SEPTEMBER 17TH -12PM
AIRPORT - SEPTEMBER 17TH -1PM
AIRPORT - SEPTEMBER 17TH -2PM
25TH DISTRICT- SEPTEMBER 29TH -8AM
25TH DISTRICT- SEPTEMBER 29TH -9AM
25TH DISTRICT- SEPTEMBER 29TH - 10AM
3RD DISTRICT- OCTOBER 8TH -8AM
3RD DISTRICT- OCTOBER 8TH - 9AM
3RD DISTRICT- OCTOBER 8TH -10AM
POLICE TRAINING CENTER- NOVEMBER 19TH -11AM
POLICE TRAINING CENTER- NOVEMBER 19TH -2PM
POLICE TRAINING CENTER- NOVEMBER 19TH -3PM
If you are attending the 25th district, 3rd district or Police Training center, will you be getting a flu shot?
*
Yes
No
Will your spouse be attending with you?
Submit
Should be Empty: