CCACC At-Home Rapid Test Kits Pre-register    新冠病毒居家試劑預先登記表
Please fill out the form below to reserve your kits, and contact us at 240-393-5950 to make an appointment for pick up. 請填寫表格,並致電240-393-5950 預約領取時間。
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First Name 名 *
Last Name 姓 *
Email 電郵
Phone number 電話
Zipcode 郵政編碼
Race 種族 *
Occupation 職業 *
Do you speak 請問您能說下列幾種語言 *
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