Convention 2023 Attestation Form

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QUESTIONNAIRE to be completed before arriving at Convention :

Name *

Today's Date *

YYYY

Email *

Have you been confirmed by a health care provider to have COVID-19 in the past 10 days?
*

Yes

Are you currently awaiting COVID-19 testing results? *

Yes

Have you been in close contact (within 6 feet) with an individual who has been diagnosed to have COVID-19 as determined by a health care provider in the past 5 days?
*

Yes

Are you exhibiting any of the symptoms associated with COVID-19 that cannot be attributed to another health condition and/or physical activity?
*

Yes

I will notify Rick Wronzberg or Mark Givarz at convention@fjmc.org immediately if I or anyone in my household tests positive for COVID-19 within 14 days of my arrival at convention. *

I agree

Irrespective of test results, if you are experiencing any COVID symptoms (including new/increased allergic symptoms, cold symptoms, etc.), please contact Mark or Rick before departing for Philadelphia.
*

I agree

At the Marriott

Every participant has agreed to do their best to mitigate the risk of Covid spread while at Convention. While not mandated, we ask that you please strongly consider wearing a mask in indoor spaces, out of respect and consideration for others in attendance

We will have rapid Covid-19 antigen tests available, as well as extra masks and hand sanitizer. If you experience any symptoms, please notify Rick or Mark immediately to arrange testing.

If you test positive during your stay at the Marriott, we ask that you, as well as any roommates, quarantine in your room, until transportation arrangements can be made for the person or persons to leave the hotel and get you back home safely. We do ask that you arrange to depart from the hotel as soon as possible to limit the risk of exposure. While arrangements are being made, we will have meals and snacks provided for drop off to your room.

I agree

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