VACCINATION(S) REQUEST

Each year, NBU provides influenza vaccinations to employees. Like all vaccinations, not being on NBU’s health insurance does NOT disqualify an employee from receiving the vaccine. Spouses and dependents who ARE on NBU insurance are also eligible for vaccines. If you or one of your children on NBU’s health insurance would like to receive the vaccination, please complete the form. 

Please complete and submit a form for EACH individual requesting a vaccination(s).

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Vaccinations Requested (NBU does NOT keep records of previous vaccinations)
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I would like to receive my flu vaccination at...

Your request has been submitted.