Language
English (US)
Chinese
Senior Appreciation Luncheon
August 21st, 2022 - 12PM-3PM
Registration Form
Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Gender
*
Male
Female
Email (Optional)
example@example.com
Vaccination Status
To ensure safety of all attendees of the event, a up-to-date vaccination is required. Up-to-date vaccination is defined as completing a 2-dose mRNA series or one dose of J&J and a booster dose.
Are you up-to-date with vaccinations?
*
Yes
No
How did you hear about the event?
Newspaper
A Friend
Email
Dharma Seal Temple
Other
Submit
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