The Vaccine People | Flu, Clinic, Travel Health, Travel Vaccine, Travel Immunization, Travel Vaccination, Travel Medicine, Vaccines for Travel

Please fill-in and submit the form below as soon as possible for the best chance to accommodate your first choice of dates. We will contact you to confirm your requested date and time. Pricing for the flu season is $25.00 per shot. If you have questions, please CONTACT US .

Name
Company
Address
City
State & ZIP
Phone
E-mail

Requested Flu Clinic Dates
1st Preference
2nd Preference

	Who will be paying for the shot? company individual

	Estimated number of participants

	If this is for a company, please provide the name of the person authorizing the flu clinic.