2020 Influenza Vaccine Registration Form

To Register yourself or your loved one for the 2020 Influenza vaccine, Click “Sign Document” and log in below.  You must use a valid email – as a part of the signing process, you will receive a confirmation email.

Fill in as much information as you can to help us make sure everything is correct.  Please sign the form at the end.

 The form is ONLY considered complete when you click “Confirm Document” in the confirmation email.