Add My Signature To Public Health School Mask Mandate Open Letter

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Please complete this short form so we can verify and add your name to the open letter at www.medium.com/@pubhealthschoolmasks. Please note if you must sign in your personal capacity and without publicly identifying your employer. You may receive an email within 24 hours of completing this form from pubhealthschoolmasks@gmail.com to verify your consent to be listed among the signatories. Thank you!

First Name *

Last Name *

Degree or Personal Title *

Full Name (as you would like it to be shown in the list of signatories) *

Occupation or Job Title *

Company, Organization, or Institution *

Work Email Address (for use only to verify your identity) *

State/Territory Residence *

Link to LinkedIn profile, faculty profile, or other online bio/CV for verification purposes (please enter "none" if you are unable to provide a link) *

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