Flu Shot Registration Form
A flu shot this season can help reduce the burden on our healthcare systems responding to the COVID-19 pandemic. Flu shots will be administered at the Drive Thru Flu Shot Clinic 12/11/2020 11am-3pm located at Beaumont Teen Health Center- Westwood 25912 Annapolis St. Inkster, MI 48141. After registering, you will have an option to take the flu quiz for a chance to win a grand prize! A completed quiz is an automatic entry into the raffle. You must attend the Drive Thru Flu Shot Clinic to claim your prize. Contact Your goodVillage Collective with questions at 888-357-2366 or
info@ygvc.org
.
* Required
Email address
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Your email
Frist and Last Name
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Your answer
Phone Number
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Your answer
Please select your city
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Wayne
Inkster
Westland
Other:
Required
How many adults will be receiving a flu shot?
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Your answer
How many children will be receiving a flu shot?
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Your answer
How did you hear about the Drive Thru Flu Shot Clinic?
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Your answer
Would you like to take the flu quiz for a guaranteed entry into a raffle for a grand prize?
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Yes
No
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