Flu Vaccination Registration Any questions or if you would prefer to complete this form over the phone, please call us on 01280 851113. YOUR DETAILS First Name * Surname * DOB * Email * Phone Employer Any Comments YOUR AGREEMENT * I confirm that the information I have given is accurate and agree that Gemelli can contact me using the details given above. DATA PROTECTION The information that you provide on this form will be used in a confidential manner to help us process your request to use one of the services we provide to your employer. We abide by the Data Protection Act and General Data Protection Regulations. We are conscious of only taking the personal data from you that we require and will keep it safe and secure. Please confirm you understand and agree to this Data Protection Statement and that we need to take details about you to process this application. You can find details of how we process your personal data in our Privacy Policy on our website. * I confirm I understand and agree with this Data Protection Statement. SUBMIT YOUR REGISTRATION Please now submit your registration by clicking on the button below. One of our team will be in touch shortly – thank you. reCAPTCHA If you are human, leave this field blank. Submit
