What is the race/ethnicity you most identify with? *
Phone Number *
Your answer
What is your Bloomington address? *
Your answer
Have you exhibited any of the following symptoms in the past 14 days? Fever or Chills, Cough, Shortness of Breath or Difficulty Breathing, Fatigue, Muscle or Body Aches, Headache, New Loss of Taste or Smell, Sore Throat *
Have you, or anyone you have been in contact with, tested positive for COVID-19 in the past 14 days? *
Do you understand you must self report with IU and you cannot attend the event(s) if you begin to exhibit symptoms or come into contact with someone who tested positive for COVID-19 from the time you complete this form until the scheduled event(s)? *
Do you understand you must wear a mask and social distance throughout the entire event? If you fail to do so, you will be asked to leave the premises. *
One more reminder to bring your mask, ID and funds for WIUX merch *
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