WIUX Culture Shock Merch Registration
Please complete the following form and check in with the entrance table with a picture ID when you arrive to receive your ticket.
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Full Name *
IU Email *
What Year are you in? *
What is your major? *
Are you a member of WIUX? *
Which Gender do you most identify with *
What is the race/ethnicity you most identify with? *
Phone Number *
What is your Bloomington address? *
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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