National Influenza Vaccination Week: Submit Your Plans

The 2014-15 NIVW activity submission form is now active. Please use the form below to submit your activities for NIVW. If your events are seasonal flu activities that aren't taking place specifically in observance of NIVW, please submit your plans on this page.

* required

Organization Name:*

Contact:*

Title:

Address:*

City, State, Zip:*

Phone:*

Fax:

E-mail:*

Web Address:

Name of Activity:*

Activity Date and Time:*

Target Audience:*

Type of Activity:*

Activity Description:*

Community Partner Listing:

Evaluation and/or Follow-up Plans:*
Include any information you plan to obtain and report such as: number of vaccinations, number that attended and/or received materials, website metrics where applicable, information requests that were difficult to meet, lessons learned, etc.

May we post your city and activity description on the CDC Seasonal Influenza (flu) Website?
Yes No

May we contact you?
Yes No

Respond to the challenge above to get a value to enter in this box:

Syndicated Content Details:
Source URL: http://www.cdc.gov/flu/NIVW/form.htm
Source Agency: Centers for Disease Control and Prevention (CDC)
Captured Date: 2016-10-18 14:11:25.0