Mobile Number

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Full Name

Mobile Number

Address

Email Address

Team/Group Member

Information for Health and safety

Have you traveled to any COVID-19 infected country in last 15-days? *

Yes
No

Came in contact with anyone who has traveled to country infected with COVID-19 in last 15 days? *

Yes
No

Do you have cough? Dry or mucus? *

Yes
No

Have you any respiratory discomfort or problem breathing? *

Yes
No

Upset stomach/Diarrhea or have you been vomiting? *

Yes
No