Survey Sign Up

Participant's E-Mail Address

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	In order to participate, we need a valid e-mail address. Please enter your e-mail address below and enter the code shown. Once you click on 'I Agree' below, you will be sent an e-mail to confirm your registration. Please follow the instructions on the confirmatory e-mail.
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All of the information you provide is voluntary, and your responses are transmitted to us via an encrypted web connection. Each week during the flu season (October to May), you will receive a reminder e-mail from us containing the web link for the weekly survey. You may opt out of receiving our reminder e-mails at any time by notifying us via the e-mail or telephone number we will provide to you. From time to time, we may also ask you to participate in other population surveys. If we do so, you will receive additional information on that survey and will have the option to participate. You will also have the opportunity to ask questions regarding the tracking system. By submitting the information above, you are giving consent to the Maryland Department of Health and Mental Hygiene to use your non-identifying information and your weekly responses for flu tracking purposes.