UD Faculty / Staff Wellness Program Fall Semester,  2009
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Flu Shot Registration

Don't Forget, Faculty and Staff will pay $10.00.  Dependents will pay the full cost of the shot, which is $26.00.
Payment due at time of vaccination!

Please print/download the Influenza Immunization Release Form, complete the necessary information; SIGN the form, and bring with you to your appointed time. Thank you.
Full Name:
Phone Number:
Email Address:
Campus + ZIP:

Sex:
Age:

October 20
University of Dayton
Kennedy Union 211
8:00-11:00am





































   
October 28
University of Dayton
Kennedy Union 211
8:00-11:00am  




































   
October 29
Wright Patterson Air Force Base
Building 653, Room 109
9-10am
9:00-10:00am
 

 
Dr. Lloyd L. Laubach
Director , Wellness Program


For information on Wellness Programs, please contact:
Theresa Gilbert, RD LD
Graduate Assistant, Wellness Program
Frericks Center Room 53
University of Dayton
300 College Park
Dayton, OH 45469-1210
(937) 229-3662
Fax (937) 229-4244
gilbertl@notes.udayton.edu