2019 HASMB Medical & Contact Information
Attention All HASMB Performers and Accompany Travelers.

Please complete following contact & medical information questions. Additional (i.e., medical consent) forms will need to completed as well which will be distributed at later date.

Deadline to complete this information February 30, 2016.

Please contact Claire Kim if you have any questions - hasmb808@gmail.com.

Name of Performer/Traveler *
Your answer
Email Address *
Your answer
Cell Phone *
Your answer
Contact Information - Address
Name - Emergency Contact *
Your answer
Relationship
Your answer
Cell Phone Number - Emergency Contact *
Your answer
Can this person respond to text messages
Home Phone Number - Emergency Contact
Your answer
Work Phone Number - Emergency Contact
Your answer
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