Flu Shot Registration

LEHB Flu Shot Registration
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Are you bringing any of your dependents ? If so please list their names. If you are coming alone, just write N/A.
What Flu Shot Event would you like to attend? (IF YOU ARE ATTENDING A DISTRICT OR UNIT YOU DO NOT HAVE TO PICK A TIME, you can just check the box for the corresponding date and location!)
If you are attending the October 28th event, what time would you like to arrive?
Do you have any other questions or comments?
How did you find out about Flu shots?
Should be Empty:

LEHB Flu Shot Registration