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VRCMC Member Register:
* * * This register is to be completed after each visit to the club ! ! !
By submitting your details you confirm that the information provided is truthful and correct.
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* Indicates required question
Email
*
Your email
Name & Surname
*
Your answer
SAMAA Number (type NONE if you're a non-flying member)
*
Your answer
ID Number
*
Your answer
Physical Address
*
Your answer
Cellphone Number
*
Your answer
Date of Visit
*
MM
/
DD
/
YYYY
Time In
*
Time
:
AM
PM
Time Out
*
Time
:
AM
PM
Temperature reading on arrival?
*
Your answer
Do you currently have any of the following symptoms?
*
Yes
No
Fever > 37.5
Cough
Sore Throat
Redness In Your Eyes
Difficulty Breathing
Body Aches
Loss of Taste and/or Smell
Nausea or Vomiting
Diarrhea
Weakness / Tiredness
Yes
No
Fever > 37.5
Cough
Sore Throat
Redness In Your Eyes
Difficulty Breathing
Body Aches
Loss of Taste and/or Smell
Nausea or Vomiting
Diarrhea
Weakness / Tiredness
In the past 4 weeks have you returned from an international trip?
*
Yes
No
In the past 4 weeks have you been in contact with a person who tested positive for Covid-19?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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