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CaseyU3A vacinnation advice form
To meet state & local government requirements for Covid 19, CaseyU3A members must be double vaccinated to attend all classes. This form provides member vaccination information for CaseyU3A to proceed with classes.
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* Indicates required question
CaseyU3A
First Name
*
Your answer
Last Name
*
Your answer
Have you received both doses of Covid 19 vaccination?
*
Yes
No
Required
Date of second vaccination
*
MM
/
DD
/
YYYY
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